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New Requirements for TPMO When Selling Medicare Advantage and/or Part D Plans

The Centers for Medicare & Medicaid Services (CMS) have released their final ruling on requirements for the marketing and communication of Medicare Advantage and Part D plans. The requirements are aimed at safeguarding Medicare beneficiaries and include requirements for disclaimers and recording of phone calls. If Medicare Part D is included in a bundle with another product, the sales process is still subject to this law. There has been an increase in complaints to CMS as it relates to misleading advertisements f rom third-party marketing organizations (TPMOs) and CMS has now expanded the definition of TPMO to include agents and brokers. If you sell Medicare Advantage or Medicare Part D plans, you are required to follow these new regulations and must be in compliance by October 1st, 2022.


Disclaimer:

This exact disclaimer must be used in the following places:

“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.”

  • Verbally conveyed within the first minute of a sales call or in-person meeting.

  • Electronically or in writing when interacting with the beneficiary through email, online chat other electronic means of communication.

  • Prominently displayed on your website

  • Included in any marketing materials such as print materials and television advertising.


Call Recording Requirement:

All sales calls with beneficiaries must be recorded in their entirety. This means that all marketing calls with both clients and prospects where Medicare Advantage and Medicare Part D plans are discussed must be recorded. The recordings must also be retained in a HIPAA-compliant manner for 10 years.


Any conversation within the “chain of enrollment” must be recorded. This includes everything from the moment a beneficiary becomes aware of Medicare Advantage or Part D plans to the enrollment process itself. Medicare supplements are not included in the new call recording rules.


In-person, face-to-face marketing and sales meetings are excluded from the recording

requirement (not the disclaimer requirement), however, follow-up calls related to those meetings would need to be recorded. Also, agents must report any staff disciplinary actions associated with Medicare beneficiary interaction on a monthly basis.


What You Need to do

Disclaimer:

  • Update your website footer and any contact/submission form on your website to include: “We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.”

  • Update any marketing materials supplied via hard-copy or email to include the disclaimer.

  • If you use a chatbot or online messaging system with clients, add the disclaimer so it’s prominently displayed.

  • Create a new Medicare-only email signature which includes the disclaimer.

  • Update workflows to include a review of the disclaimer when on the phone or having an in-person contact.


Recording Phone Conversations:

  • Record all conversations following CMS guidelines

  • Save all conversations in a HIPAA-compliantsystem for ten years



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