Blogs — 9/12/2023_Article 1

Medicare Has Some New Rules for 2024

A couple of days ago, I sent out a summary of the upcoming AEP (10/15 – 12/7). Today’s newsletter takes a look at Medicare news and some rules that have an impact on the 2024 AEP.

You probably all remember the annoying ads over the last two years (we call them the Joe Namath ads) that were hawking Medicare plans that offered basketfuls of goodies, and led many Medicare beneficiaries to believe that Medicare had now become free and covered all medical care for free?! Remember those — I have never seen anyone smile so broadly as Joe did on those ads! Well, CMS wasn’t so thrilled — since their complaint load quadrupled!! Did I mention that CMS HATES complaints and really, really hates it when complaints increase in number.

Those of us in the Medicare insurance business took immediate notice of those ads because they seemed to violate multiple compliance requirements that had been set forth by CMS (Medicare) in their annual Medicare Marketing Guidelines regulations — a voluminous publication loaded with restrictions on what one cannot do when offering Medicare plans to people. We we very sensitive to these ads. CMS requires all of us to undergo a lengthy national certification process — at our own expense — EVERY year — followed by certification courses required by EACH of the carriers for whom we offer Medicare Advantage or Prescription Drug plans.

Even though a careful analysis, which I did, showed that most of the ads came very close to compliance violations, but did not cross the line. The one thing they all seemed to violate was the use of the term “Medicare” in the names of the so-called “helplines.” No wonder people were confused! Especially irksome was that during this time CMS apparently did nothing to curb the misuse of the Medicare name, or the suggestive claims made, clearly designed to steer people to the call centers (another violation, by the way).

Even though the advertising efforts apparently failed to produce the results expected by investors, leading to the demise of the campaigns, CMS has now produced a whole new batch of regulations, much of which rehashes what was already in place several years, and promises to aggressively enforce these “new” rules. I thought it would be beneficial for all my clients and those others reading this post, to go over the newest regs.

First, as suggested in the paragraphs above, we should see far fewer and less suggestive ads along the lines of what we experienced a couple of years ago. Whether this is due to increased government oversight or simply the proven failure of the program to attract new investors, it will be nice not to have to have such advertising wash over us with clearly suggestive, but not entirely accurate, claims.

Along these lines, let me add that Medicare Advantage and Prescription Drug plans are proposed by insurance companies and contracted by CMS ANNUALLY in a “bid” process that begins in March and concludes by June/July. As such, and because of the annual term of the contracting, we can see altered costs and benefits in these plans to reflect changes in the real world. The Annual Notice of Change (ANOC) documents that members receive in September each year reflect these changes.

…….now go back and check out more news in Medicare Has Some More Rules for 2023!

R Allan Jensen
September 12, 2023