Medicare Part C & D Marketing Guidelines & WI Senior Medicare Patrol Updates Fall 2019 Medicare Training for Wisconsin Professionals Funded by: This project was supported, in part by grant number 90MPPG0041-01-00, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy

Senior Medicare Patrol The mission is… to empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling, and education.

Medicare Part C & D Marketing Guidelines Rules that insurance companies and plan representatives (insurance agents and brokers) must follow when selling Medicare Advantage plans, Part D plans, cost plans, employer/union-sponsored group Adv and Part D plans, and Medicare- Medicaid plans (with some exceptions) Meant to prevent plans from presenting misleading information about plan costs or benefits Includes rules for how plan representatives may contact and market to beneficiaries

Communications vs. Marketing Communications: activities and materials that provide information to current and prospective enrollees Marketing: a subset of communications that has the INTENT to influence a beneficiary’s decision about their healthcare coverage and includes marketing information

Communications May not provide inaccurate or misleading information, or engage in activities that could mislead or confuse beneficiaries or misrepresent the plan May not discriminate based on race, ethnicity, national origin, religion, gender, sex, age, mental or physical disability, health status, receipt of health care, claims experience, medical history, genetic information, evidence of insurability, or geographic location May not target higher income areas

Communications May not state or imply that plans are only available to seniors rather than to all Medicare beneficiaries May not claim that they are recommended or endorsed by CMS, Medicare, or the Department of Health and Human Services (DHHS) May not use the word “free” to describe: Zero-dollar premium Reduction in premiums, reduction in deductibles or cost sharing Low-income subsidy (LIS) Cost sharing for individuals with dual eligibility

Communications Must include the plan type at the end of each plan name on all communication or marketing materials when the plan name is mentioned Example: HMO could be named “Golden Medicare HMO” or if named “Golden Medicare Plan”, must add “(HMO)” so that the plan type if clear

Marketing INTENT – to draw a prospective or current enrollee’s attention to a plan or group of plans to influence a beneficiary’s decision when selecting and enrolling in a plan or deciding to stay in a plan (retention-based marketing) AND CONTENT – information intended to draw attention to a plan or influence a beneficiary’s enrollment decision, including: Information about benefits of benefit structure; Information about premiums and cost sharing; Comparison(s) to other plans; Rankings or measurements in reference to other plans; Information about Star Ratings

Educational Events Explicitly advertised as educational Can include communication activities and distribution of communication materials Beneficiary-initiated questions can be answered Can set-up marketing appointment and distribute business cards and contact info for beneficiaries to initiate contact

Educational Events “Don’ts” Cannot include marketing or sales activities Cannot distribute marketing materials or enrollment forms

Marketing/Sales Events Designed to steer or attempt to steer potential enrollees, or retain current enrollees, toward a Plan or limited set of Plans

Marketing/Sales Events Requirements Must submit presentations, including ones by agents/brokers, to CMS prior to use Any sign in sheet must be clearly labeled as OPTIONAL Health screenings or other activities that may be perceived as, or used for, “cherry picking” are not permitted Contact information provided for raffles or drawing may only be used for that purpose May not require attendees to provide contact information as a prerequisite for attending

Scope of Appointment (SOA) Scope of appointment documentation is required for all marketing appointments Discussions during the appointments may only concern previously agreed-upon plan products documented in the SOA

SOA Requirements Included on all SOA forms or recorded calls: Product types to be discussed Date of appointment Beneficiary and agent contact information The following language/statement: “No obligation to enroll, current or future Medicare enrollment status will not be impacted, and automatic enrollment will not occur.” A new SOA is required if, during an appointment, the beneficiary requests information regarding a different plan type than previously agreed upon.

Marketing Timing Plans cannot begin marketing for the Fall Annual Enrollment Period (October 15 – December 7) until OCTOBER 1 each year

Contacting Beneficiaries During Fall AEP Plans are allowed to send a beneficiary unsolicited mail and email, but email must have an opt-out option Unless an individual is currently enrolled in an insurance company’s plan or has given permissions, plans are not allowed to: Contact individuals by phone, text message or social media Visit individuals Leave promotional materials at an individual’s home Approach individuals in public to market the plan

Contacting Beneficiaries by Phone

Tips for Clients during Fall AEP No need to make a decision immediately! Read current plan’s Annual Notice of Change of Explanation of Coverage to learn about changes Contact plan to request a copy if not mailed Contact plan with any questions and ask for confirmation of the benefits in writing

How can the Wisconsin SMP help? Education Referrals

SMP Education Updated current educational message to include information about Medicare marketing guidelines Fraud Alert Issued September 2019 Periodic Facebook posts providing information and reminders

SMP Referral Process For suspected marketing violations, SMP referrals go to the CMS SMP liaison If an insurance agent is involved in the suspected violation, SMP also submits complaint to the WI Office of the Commissioner of Insurance (OCI)

Information requested for SMP Referral The more information, the better! Copies of mailing received Copies of email received, including attachment(s) Agent name, company name, and phone number

Examples of Cases Referred to CMS Liaisons Agent in van at grocery store parking lot Sign-up sheets at educational events Providing meals to prospective enrollees Agents misrepresenting their purpose to present at Senior Centers Genetic testing companies claiming Medicare plan coverage

WI SMP Updates

What are we seeing in Wisconsin? SSA & Medicare Telephone Scams Durable Medical Equipment Scams Genetic Cancer Screening Scams Marketing Guidelines & Violations What are the new scam trends, nationwide? Hearing Aids Physician Kick-Backs

SMP Resources Available Educational Presentations and Outreach Events (Expos, Wellness Fairs, etc.) Helpline (888) 818-2611 Personal Health Care Journals Quarterly Newsletter, The Scoop

How SMP Thrives Volunteer Support Distribute Information & Materials Give Presentations (like this one!) Staff a Table at Events & Fairs Join the SMP program as a volunteer!

Contact Wisconsin SMP Greater Wisconsin Agency on Aging Resources (GWAAR) Visit us online: www.GWAAR.org/SeniorMedicarePatrol Like us on Facebook: @WisconsinSeniorMedicarePatrol Send an email: Smp-wi@gwaar.org Call Toll-free: 1-888-818-2611 To report suspected fraud/abuse For training, speakers, and/or materials To volunteer with the SMP program