Marketing Medicare Part D Plans

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Marketing Medicare Part D Plans

• Presented by
• Americas Health Insurance Plans (AHIP)
• and
• The National Association of Health Underwriters
  (NAHU)

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Medicare Part D Plans

• Part D plans include
• Prescription Drug Plans (PDPs),
• Medicare Advantage Prescription Drug (MA-PD)
  plans,
• Cost Plans that offer Part D prescription drug
  coverage, and
• Program of All-Inclusive Care for the Elderly
  (PACE) plans.

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Providing Information to Make a Medicare Health
Plan Choice

• Ensuring Medicare beneficiaries have information
  they need to make informed choices among the
  coverage options available under the Medicare
  Prescription Drug Benefit (Part D) is critical to
  the new programs success.
• Participating health plan sponsors are committed
  to providing beneficiaries with accurate and
  understandable information.
• CMS Marketing Guidelines are the foundation for
  ensuring accurate information by developing
  proper marketing materials and promotional
  activities.

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Marketing Guidelines Background

• The Centers for Medicare Medicaid Services
  (CMS) established Marketing Guidelines for its
  Medicare health plans based on
• Federal regulations
• Current industry practices
• Technology advancements
• Interest in protecting Medicare beneficiaries
• Marketing Guidelines apply to
• Medicare Advantage (MA) plans,
• Medicare Advantage Prescription Drug (MA-PD)
  plans,
• Prescription Drug plans (PDPs), and
• 1876 Cost plans
• Link to Medicare Marketing Guidelines
  www.cms.hhs.gov/PrescriptionDrugCovContra/Download
  s/FinalMarketingGuidelines.pdf
• Some State laws also apply to broker and agent
  marketing and sales activity for Medicare health
  plans.

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CMS Definitions

• Marketing Steering, or attempting to steer, an
  undecided potential enrollee towards a plan, or
  limited number of plans, and for which the
  individual or entity performing the marketing
  activities expects compensation directly or
  indirectly from the plan for such marketing
  activities. Assisting in enrollment and
  education do not constitute marketing.
• Assisting in enrollment Assisting a potential
  enrollee with the completion of an
  application/and or objectively discussing
  characteristics of different plans to assist with
  enrollment based solely on the enrollees needs
  and without compensation from the plan.
• Education Informing a potential enrollee about
  Medicare programs, but not steering towards a
  specific or limited number of plans.

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Plan Sponsors May Contract with Brokers Agents
to Market Medicare Health Plans

• To reach Medicare beneficiaries across the
  country, Medicare health plan sponsors frequently
  contract with brokers and agents to
• Carry out marketing efforts
• Disseminate information about their plans and
• Sell Medicare health plan packages.

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Responsibility for Marketing the Plans

• Plan sponsors are responsible for all of the
  marketing activities of third-parties contracted
  to carry-out Medicare health plan business
  including a person who is
• Is directly employed by the organization
• With which an organization contracts and
• A downstream marketing contractor.
• If a state requires, plan sponsors must use only
  a state licensed, certified, or registered
  individual to perform marketing.

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Plan Sponsors Ensure Compliance

• Plan sponsors must establish clear provisions in
  the broker/agent contracts that the organization
  is responsible for ensuring the contractors
  comply with
• applicable MA and/or Part D laws,
• Federal health care laws, and
• CMS policies and Marketing Guidelines
• Plan sponsors must conduct monitoring activities
  to ensure compliance.

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Plan Sponsors Require Training of Contracted
Brokers/Agents

• Plan sponsors typically establish certification
  requirements that brokers/agents must meet to
  qualify to market and sell the sponsors health
  and Part D prescription drug plans.
• Requirements often include completing at least a
  full day of training for all potential
  brokers/agents.
• After the training program, brokers/agents must
  demonstrate they are knowledgeable about key
  aspects of the Part D plans, policies,
  procedures, and applicable CMS requirements.

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Broker/Agent Training Topics

• Training programs typically address a range of
  topics, including
• Medicare marketing rules - permissible and
  prohibited practices
• Product benefit design
• Medicare eligibility enrollment rules
• Enrollment forms required disclosures that must
  be made to beneficiaries
• Grievance appeals processes
• Oversight monitoring by plans and
• Corrective disciplinary action.

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Broker/Agent Training Updates

• Broker/agent training programs are frequently
  updated.
• Plan sponsors often require brokers/agents to
  attend re-training sessions to remain certified.
• Many plan sponsors
• Hold regular conference calls to reinforce
  information provided during training sessions,
• Keep their brokers/agents informed of current
  issues, and
• Offer other avenues for brokers/agents to ask
  questions.

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Continuous Oversight

• Plan sponsors have developed a variety of
  mechanisms to continuously monitor broker/agent
  performance and compliance with CMS, state, and
  sponsor requirements.
• Oversight activities of the plan sponsor may
  include
• Telephone calls to new members upon enrollment to
  ensure that they understand the terms of the Part
  D plan they have joined
• Broker/agent phone call monitoring and review to
  ensure compliance with appropriate marketing
  practices
• Targeted ride-alongs conducted by plan sponsor
  employees based on complaints
• Attending community meetings to evaluate
  presentations and/or
• Monitoring of disenrollment rates and complaints
  for each broker/agent.

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Compliance with State Law

• State marketing agent appointment laws do not
  apply to Medicare plans because the Medicare
  Marketing Guidelines address the use of marketing
  representatives.
• However, because a plan sponsor is required to
  use only a state licensed, registered, or
  certified individual to market a plan (if a state
  has such a requirement), CMS expects plan
  sponsors to comply with a reasonable request from
  a state insurance department (or other state
  department)
• that licenses individuals for the purpose of
  marketing insurance plans and
• that is investigating a person who is marketing
  on behalf of a plan sponsor if the investigation
  is based on a complaint filed with the state
  insurance or other department.

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Reporting Violations to State Agencies

• Plan sponsors are encouraged to report a person
  that markets on a its behalf to the appropriate
  state entity, if there is suspected violation of
  a states licensing, registration, certification,
  insurance, or other law.
• States may take action against marketing
  representatives and insurance producers for
  alleged violations of state marketing
  representative licensing laws.
• This requirement applies to any individual
  performing marketing on behalf of a PDP sponsor
  or MA organization, whether the individual is an
  employee, an independent agent contracting with a
  PDP or MA organization, or a downstream
  contractor.

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State Reporting Laws

• The plan sponsor must report to the state the
  following information if state law requires such
  reporting
• The identity and other information of a
  broker/agent who is marketing the organizations
  plan(s).
• The termination for cause of a brokers/agents
  employment or contract.

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Broker Compensation Agreements

• Compensation schedules must
• Be specified in a written contract.
• Provide reasonable compensation that is in line
  with industry standards for services provided.
• Rate of payment
• Must be related to a reasonable measure of
  service provided.
• May vary among plans (e.g., MA plan, MA-PD plan,
  or a PDP).
• May vary among one organizations plans.
• May not vary based on the health status or risk
  profile of a beneficiary.

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Broker Compensation Agreements

• Compensation structures must
• Avoid incentives to mislead beneficiaries, cherry
  pick certain beneficiaries, or churn
  beneficiaries between plans.
• NOTE Special Needs Plans are permitted to market
  to individuals based on the eligibility
  requirements of the plan.
• Withhold or withdraw payment if an enrollee
  rapidly disenrolls (e.g., disenrolls less than 60
  days after enrollment).
• Not include payments outside of the compensation
  schedule set forth in the written contract.
• Not include payments by persons performing
  marketing to beneficiaries.

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Marketing Outbound Telemarketing

• CMS allows outbound telemarketing to reach
  beneficiaries under the following guidelines
• Must be for health related products (e.g.,
  discounts on eyeglasses or health club
  memberships)
• May not be for non-health related items ( e.g.,
  discounts on restaurants, entertainment, or
  travel) unless the beneficiary provides prior
  written authorization.
• Must comply with the National-Do-Not Call
  Registry.
• Must honor do not call again requests.
• Must abide by Federal and State calling hours.
• Must not enroll beneficiaries over the phone.

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Marketing Outbound Telemarketing

• Outbound telemarketing may be used solely to
• Solicit requests for pre-enrollment information
• Describe benefits
• Alert existing beneficiaries to new benefits or
  health-related offers and
• Conduct follow-up calls to establish the receipt
  of requested information and field questions
  regarding programs.

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Marketing Materials - Approval

• Agents/brokers must use only CMS-approved
  materials and scripts when calling prospective
  clients and describing benefits.
• CMS reviews marketing materials submitted by the
  plan sponsor to ensure they
• Are not materially inaccurate,
• Are not misleading, and
• Do not otherwise make material misrepresentations.
  

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Marketing Materials Outbound Script Requirements

• Scripts must include a privacy statement
  clarifying the beneficiary is not required to
  provide any information to the plans
  representative and that the information will in
  no way affect the beneficiarys membership in the
  plan.
• Plans may not request beneficiary identification
  numbers including SSN, bank account, credit card,
  or HICN through pre-enrollment scripts.
  (Information can be requested in the application
  the enrollee completes.)
• Plans may say they are contracted with Medicare
  to provide prescription drug benefits or that
  they are a Medicare-approved MA-PDP/PDP, but they
  may not say they are endorsed by Medicare,
  calling on behalf of Medicare, calling for
  Medicare, or working for the federal government.
• Plans cannot say their plan is the best plan.

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Marketing Activities Door-To-Door Solicitation
Prohibitions

• Marketing agents may not
• Solicit beneficiaries door-to-door prior to
  receiving an invitation from the beneficiary to
  provide assistance in the beneficiarys
  residence.
• Return uninvited to an earlier no show
  appointment.
• Marketing agents may market and distribute and
  accept enrollment applications in common areas of
  health care settings e.g., cafeteria, rec. room,
  conference room

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Marketing ActivitiesUnsolicited E-mail
Prohibitions

• Marketing agents may not
• Send e-mail to a beneficiary, unless the
  beneficiary agrees to receive e-mails from the
  plan sponsor and provides his/her e-mail address.
• Rent an e-mail list to distribute plan
  information.
• Acquire e-mail addresses through any type of
  directory.

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Promotional Activities General Guidelines

• Agents and brokers may not
• Use free gifts, prizes, cash or rebates as an
  inducement for enrollment.
• Use cash promotions to induce a referral,
  recommendation, or purchase of an item or service
  of the Medicare program.
• Offer post-enrollment promotional items to
  compensate beneficiaries based on their
  utilization of services.

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Promotional Activities Nominal Gifts

• Agents/brokers may offer gifts to potential
  enrollees if they attend a marketing presentation
  if
• Gifts are of nominal value (15 or less), based
  on retail price
• More than one gift is offered, the combined value
  of all items does not exceed 15
• Gifts are offered to eligible members without
  discrimination
• Gifts are provided regardless of whether the
  individual enrolls in the plan and
• Gifts are not in the form of cash or monetary
  reward (i.e., charitable contributions on behalf
  of an attendee, gift certificates, gift cards)

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Promotional Activities Drawings, Prizes,
Giveaways

• Brokers/Agents
• May offer a prize over 15 to the general public
  as long as it is not offered just to Medicare
  beneficiaries and is not routinely or frequently
  awarded.
• May not use free gifts or prizes to induce
  enrollment.
• Must include a disclaimer on any statement
  concerning a prize or drawing that there is no
  obligation to enroll in the plan.

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Promotional Activities Referral Programs

• Brokers/agents may not use cash promotions as
  part of a referral program, but may offer thank
  you gifts of less than 15.
• Thank you gifts are limited to one gift per
  member per year.
• A letter sent from an agent or broker to members
  soliciting referrals cannot offer a gift for a
  lead.
• An organization can request referrals from active
  members including names and addresses, but not
  phone numbers. (Information can be used for mail
  solicitation.)

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Health Fairs Health Promotional Events

• Policies for health fairs health promotional
  events apply to
• Sole-Sponsor (single sponsor for an event)
• Multiple-Sponsor (more than one sponsor for an
  event)
• Both (single multiple-sponsor events)
• In a Sole-Sponsor event
• If offered, door prizes/raffles cannot exceed the
  15 limit for each item based on retail value.
• In a Multi-Sponsor event
• Door prizes/raffles can exceed the 15 limit if
  the agent/broker contributes to a pool of cash
  for prizes (e.g., a get-away weekend) or a pool
  of prizes so that the prize(s) is/are not
  individually identified with the plan sponsor,
  but rather is identified with a list of
  contributors.

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Health Fairs Health Promotional Events

• Both Sole-Sponsor and Multi-Sponsor events
• Should be social and may not include a sales
  presentation.
• Responses to questions will not be considered a
  sales presentation as long as no enrollment form
  is accepted.
• Ads for events may be distributed to enrollees or
  non-enrollees.
• Free items (food/entertainment) cannot exceed 15
  retail value per attending person based on
  projected attendance.
• Pre-enrollment ad materials (including enrollment
  forms) can be made available as long as
  enrollment forms are not accepted.
• Must have disability access and cannot be limited
  to affluent areas.

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Questions?