AEP Resources

You can access the latest compliance rules here.

September 30, 2023.

The rule ensures transparency and accountability by stating that MA organizations and Part D sponsors cannot promote their products, plans, benefits, or costs without clearly disclosing their name or marketing name(s) in the promotional material. (Page 386)

Why it matters: This requirement aims to provide beneficiaries with full awareness of the organization they are engaging with and who they are reaching out to for information or assistance.

According to this rule, MA organizations and Part D sponsors are not allowed to make claims about potential savings by comparing costs to individuals without insurance or those who haven’t paid their medical bills. Additionally, they cannot use costs that Medicare beneficiaries haven’t actually incurred. (Page 386)

Why it matters: This regulation aims to ensure that marketing materials provide accurate and realistic information, preventing misleading claims about potential savings.

Door-to-door solicitation refers to visiting a Medicare beneficiary’s home without prior consent or a scheduled appointment. Unless the beneficiary has explicitly agreed to a visit and the appointment details have been established in advance, such visits are considered unsolicited. (Page 391)

Why it matters: This clarification ensures that beneficiaries have control over who they engage with and receive information from regarding Medicare-related matters.

According to the requirement, every MA organization and Part D sponsor must provide written opt-out information to all their enrollees, irrespective of the organization’s intention to contact them. This provision ensures that beneficiaries are reminded annually that they have the option to opt out of receiving communication from their MA organization or Part D sponsor regarding plan-related matters. (Page 392)

Why it matters: By receiving this information annually, beneficiaries are empowered to make decisions about the extent of contact they wish to have with their healthcare provider.

The rule states that it is prohibited to distribute Summary of Benefits (SOA) cards or collect beneficiary contact information at educational events. This regulation reinstates the restriction on accepting SOA cards or gathering contact details of beneficiaries during such events. (Page 394)

Why it matters: The aim is to maintain the educational nature of these events without introducing sales or marketing activities that could potentially influence beneficiaries’ decision-making.

The rule specifies that marketing events cannot occur within 12 hours of an educational event, at the same venue. This provision ensures that beneficiaries have ample time to contemplate the impartial and factual information presented during the educational event without being immediately exposed to sales or marketing activities. (Page 399)

Why it matters: By allowing this time gap, beneficiaries can make informed decisions based on the educational content they received.

The 48-hour rule for the Scope of Appointment (SOA) aims to provide beneficiaries with sufficient time to review the information provided in the SOA before engaging in a meeting with the agent. Exceptions to this rule include cases where the beneficiary is nearing the end of a valid enrollment period or when walk-in meetings are initiated by the beneficiary without prior scheduling. (Page 406)

Why it matters: This process allows beneficiaries sufficient time to review the information provided, promoting transparency and informed decision-making, which benefits agents by building trust and credibility with beneficiaries.

The clear time limit of 12 months for Scope of Appointments (SOAs) and Business Reply Cards (BRCs) ensures that the information provided remains current and relevant. If the original SOA or permission to contact (PTC) has expired, a new one will be required to maintain compliance. (Page 410)

Why it matters: It ensures that agents provide beneficiaries with current and relevant information, promoting compliance and informed decision-making.

As part of the enrollment process, agents must clearly communicate the impact of a client’s enrollment decision on their existing coverage. (Page 414)

Why it matters: This ensures that beneficiaries are fully informed about the implications and potential changes to their current coverage.

The updated TPMO disclaimer must be included in all marketing materials, websites, brochures, or phone calls promoting Medicare Advantage or Part D insurance plans. It should be specific to the service area and should be mentioned within the first minute of any audio presentation or call. (Page 419)

Why it matters: Including the disclaimer in all relevant materials and mentioning it early in audio presentations or calls helps agents meet regulatory obligations, provide accurate information, and establish trust with potential beneficiaries.

MA organizations and Part D sponsors are required to have a monitoring and oversight plan to ensure compliance. This plan should include checking complaints, reviewing sales and marketing recordings, and evaluating web-based events without revealing the identity of the evaluator. Non-compliance by agents should be reported to CMS.(Page 425)

Why it matters: Agents should be aware of these requirements as they play a crucial role in maintaining ethical practices, fostering transparency, and upholding the integrity of the industry.

The recording of calls is now limited to those directly related to sales, marketing, and enrollment activities, rather than recording all calls. This focuses the recording efforts on specific interactions relevant to the sales process.(Page 431)

Why it matters: This change helps agents streamline their recording practices, maintain privacy for non-sales related conversations, and align their recording efforts with the specific needs of sales, marketing, and enrollment activities.

Web-based technology meetings, such as those conducted through platforms like Zoom, Facetime, or Skype, are now required to be recorded. This recording requirement applies to the audio portion of the call to ensure transparency and compliance.(Page 434)

Why it matters: Promotes transparency and compliance for agents, providing a documented record of interactions and promoting accountability in communications with beneficiaries.

The rule prohibits the misleading use of the Medicare name, CMS logo, or any products or information issued by the Federal Government, including the Medicare card. However, with authorization, there may be limited circumstances where the use of the Medicare card image is permitted.(Page 372)

Why it matters: Adhering to these regulations helps agents maintain compliance, avoid misleading practices, and ensure accurate representation when promoting Medicare-related products or information.