The 2019 Medicare Communications and Marketing Guidelines (MCMG) are finally here. It’s immediately clear that the definitive guidelines for marketing Medicare have a whole new look for 2019.

We have all the information on what the Centers for Medicare & Medicaid Services (CMS) changed for 2019, and how you can remain compliant while still having a productive, profitable year! Our review covers what we’ve found to be the most prominent modifications, but it’s also beneficial to read through the full document on your own time.

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Communications vs. Marketing

Formally known as the Medicare Marketing Guidelines (MMG), CMS’ regulations are now named the Medicare Communications and Marketing Guidelines (MCMG). One of the biggest changes in the new guidelines is how marketing materials are categorized. In the past, all marketing materials were subject to review by CMS. This year, there’s a little more leeway.

Materials will now be classified into two sections: communications and marketing. The new MCMG defines communications as “activities and use of materials to provide information to current and prospective enrollees,” making it the more general of the two. Materials that fall under this category are not subject to review by CMS.

Marketing, however, is a subset of communications. These materials are often more specific and provide detailed information. The purpose of these materials is to draw a beneficiary’s attention to a certain plan and influence their decision. These pieces could potentially include information on the plan’s benefit structure, cost sharing, and measuring or ranking standards. Marketing materials are subject to CMS review.

CMS determines the category that the material falls into by reviewing both the content and the intent of the piece. What does it say and what is your intention? Let’s look at an example from the MCMG:

“A billboard reads ‘Swell Health Offers $0 Premium Plans in Nowhere County.’”

Would this be considered communications or marketing? Because the advertisement includes both the intent to draw the reader’s attention to the plan and mentions that $0 premiums are available, this would fall under the marketing category.

Let’s look at another one for good measure:

“A letter is sent to enrollees to remind them to get their flu shot. The body of the letter says, ‘Swell Health enrollees can get their flu shot for $0 copay at a network pharmacy.’”

This one’s a little tricky! You may be inclined to pick marketing due to the “$0 copay.” However, if you look closely, this would fall under the communications category because the intent is not steer the reader into making a plan decision. Rather, it is simply to inform them that flu shots are available for members.

You can check out more examples in Section 20.1 of the full MCMG. Please note that agent-developed communication materials that are not marketing are excluded from CMS’s material ID requirement.

Contact via Email

According to the MCMG, agents are permitted to make unsolicited direct contact with potential enrollees through conventional mail and other print media, such as advertisements or direct mail.

Additionally, agents can make unsolicited direct contact with beneficiaries via email. However, in order to remain compliant, your email must contain an “opt out” function.

You would need to utilize an email marketing platform that allows you to include these opt outs, such as Constant Contact or MailChimp. While you are permitted to do this, Ritter Insurance Marketing does not recommend mass emailing unless you completely understand how to use your email marketing application.

If for whatever reason a recipient cannot opt out of your email, you may find yourself in some hot water with CMS. If you do choose to take advantage of this new rule, be absolutely certain your email is in compliance with the guidelines and the content is communications and not marketing to avoid potential consequences.

Keep in mind that you still cannot make unsolicited telephone calls to beneficiaries or approach potential enrollees in common areas to market Medicare Advantage or prescription drug plans. Permission to contact still applies before reaching out to a possible client by phone or in person.

Reinstatement of the Open Enrollment Period

The Medicare Advantage Disenrollment Period (MADP) which would normally take place from January 1 through February 14 is being replaced with the Medicare Advantage Open Enrollment Period (OEP). The new OEP will occur between January 1 and March 31 annually beginning in 2019.

During this time, clients who are enrolled in a Medicare Advantage plan (and those who are newly eligible for MA plans) will be permitted to choose a different MA plan or return to Original Medicare, with or without a prescription drug plan. The OEP is an expansion in both length and choice from the old MADP, but the MCMG puts clear guidelines into place for how agents can communicate with plan members through this period.

With this change, agents must be mindful of “knowingly targeting.” The MCMG states Plans/Part D Sponsors may not do the following (so as an agent, you should follow suit):

  • Send unsolicited materials advertising the ability/opportunity to make an additional enrollment change or referencing the OEP
  • Specifically target beneficiaries who are in the OEP because they made a choice during Annual Enrollment Period (AEP) by purchase of mailing lists or other means of identification
  • Engage in or promote agent/broker activities that intend to target the OEP as an opportunity to make further sales
  • Call or otherwise contact former enrollees or clients who have selected a new plan during the AEP through another agent

You are allowed to send marketing materials and hold one-on-one meetings, but only at the request of the beneficiary.

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The 2019 MCMG is a true rewrite of the guidelines we’ve come to know so well. These are only the main highlights that we found when comparing the latest set of rules to previous guidelines. Always remember to keep yourself informed and remain compliant in all aspects of your job, and depend on Ritter’s compliance officer, Van Hang, when in doubt.