The Medicare Open Enrollment Period is a time for anyone with a Medicare Advantage plan to check out the changes that will take effect January 1. It is also the time to expect a deluge of offers and opportunities that can sound very attractive. It’s important to know about marketing policies that can protect you.
In 2022, the Centers for Medicare and Medicaid Services revamped the requirements in response to a significant increase in complaints about deceptive marketing tactics. (Does anyone think that might be related to Joe, the quarterback, and the Medicare Advantage blitz?)
CMS considers “any organizations or individuals, including independent agents and brokers, who are compensated to perform lead generation, marketing, sales, and enrollment related functions as a part of the chain of enrollment to be Third-Party Marketing Organizations,” TPMO for short. Any TPMO marketing activity must include a standard disclaimer that meets these requirements. It must :
- List the number of plans the organization offers and include that it does not offer every plan that might be available in a given area.
- Note medicare.gov and (800) Medicare as sources that can provide more information about all the options. (CMS removed the requirement to list the local State Health Insurance Program (SHIP) as a contact, but that is still an option.)
- Include the name, logo, or both.
- Use Times New Roman, 12-point font or larger, or the equivalent, for all text, including footnotes and required disclaimers.
Now, let’s take a quick look at two recent mailers that comply with CMS’ requirements, but you need to pay attention.
Medicare Enrollment Notification Card
A friend who just turned 65 shared a folded postcard mailer he received. The bottom half contained text on front and back, the top half appeared empty.
The postcard noted, “We have reserved a time to assist you with your Medicare enrollment…. You will receive assistance with enrollment and any additional benefits and program you may qualify for at that time.” The card listed the appointment time and phone number, with the instruction, “Detach this half and save for the appointment.”
As I focused on the black text, it appeared the mandatory TPMO marketing disclaimer was missing. Then I looked more closely. There it was, printed on the top half in a very light gray text, which just blended into the white background. If I had detached the bottom half, as instructed, I probably would have tossed it and not found the disclaimer.
Medicare Open Enrollment and Medicare Advantage Plans
So far, I have received four of these from different insurance sponsors.
CMS’ revised rules are very specific about not engaging in activities that could mislead or confuse beneficiaries. These notices live up to the letter of the law but you must read them from start to finish.
Here are some of the points these mailers have in common.
- $0 monthly plan premiums: No premium does not mean the plans are free.
- $0 for in-network primary care doctors: You need to dig into plan details to find out how much you’ll pay for other services.
- A maximum out-of-pocket limit for covered services: Not mentioned are the maximum limits for 2027. For in-network services, the limit is $9,850, up from $9,250 this year, and, for out of network, it’s $14,800, an increase from $13,900.
- Dental, hearing and vision benefits: There have been many reports about plans cutting back on supplemental benefits. As challenging as it may be to find it, check out a plan’s Evidence of Coverage for complete details.
- The freedom to see any doctor you choose: This point deserves its own paragraph.
CMS has noted that out-of-network physicians, not under contract with a plan, have no obligation to treat the plan’s members, except in emergency situations. A beneficiary may choose a doctor but that doctor must agree to bill the plan. That sentence, by itself on the front page of these mailers, could be considered misleading. However, each one complied with CMS’s requirements by including a disclaimer paragraph at the end, measuring three to four inches, with text from margin to margin. That paragraph notes there is no obligation, but you MUST read it to get the complete picture.
Open Enrollment Starts Tomorrow
It’s up to you to review the changes in your Medicare Advantage plan and check out others in your area. This isn’t an easy task. You must go beyond the “bells and whistles” to the “nuts and bolts.”
- Are your physicians, providers, facilities and pharmacy still in-network?
- Are all your medications listed in the plan’s 2027 formulary?
- How much will you pay for healthcare visits, medications and supplement benefits?
- Has the quality of the plan (star ratings) improved or declined?
- If your plan will not be available next year, what options do you have?
The clock is ticking. You have until December 7 to act.
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