Over 29 million individuals receive their Medicare benefits through Medicare Advantage (MA or Part C), including plans that offer Medicare Prescription Drug Benefit (Part D) coverage.

Over 23 million individuals receive Part D coverage through standalone Part D plans.

The primary purpose of this final rule is to implement changes to the MA and Part D programs. This final rule implements changes related to marketing and communications, past performance, Star Ratings, network adequacy, medical loss ratio reporting, special requirements during disasters or public emergencies, and pharmacy price concessions. This final rule also revises regulations related to dual eligible special needs plans (D-SNPs), other special needs plans, and Medicare cost contract plans.

Source: https://www.federalregister.gov/documents/2022/05/09/2022-09375/medicare-program-contract-year-2023-policy-and-technical-changes-to-the-medicare-advantage-and

• New requirement for third-party marketing organizations (like GoldenCare)
• A new process for submitting marketing materials to CMS
• A new, broader definition of “marketing” that expands the types of materials that must be submitted to CMS.
• New requirements for agents to record all calls with beneficiaries

Additional Details: All calls with beneficiaries must be recorded in their entirety. You are responsible for compliance with this requirement. The requirements are effective now for plan enrollments beginning on January 1, 2023. As AEP is the start of marketing for plan year 2023 enrollments, this means that you should record all calls in their entirety beginning on October 1, 2022.

This rule was implemented after CMS reviewed beneficiary complaints and listened to the sales organizations’ telephonic enrollments. From this, CMS determined that many beneficiaries are confused about the enrollment process as well as the plan choices available to them. This disclaimer was created to help clear up that confusion.

Although it may feel as though the disclaimer emphasizes what you do not offer, stay focused on what you can offer your prospects. Take time to consider their experience with Medicare benefits, what kind of plan would improve their experience, and work with them to figure out what plans would be best meet their medical and financial needs.

Note: It is anticipated that CMS will conduct surveillance of telesales call recordings to assess compliance during the next year, and they expect all organizations to provide a disclaimer during sales calls.

It is important to update your documents and scripts to ensure that you are incorporating the new disclaimer in time for AEP sales.

Insurance companies voluntarily agree to participate in a state’s partnership program by offering LTCi policies that meet specific requirements:

• The policy must be Tax-Qualified
• The policy must offer inflation protection based on specific age brackets at the time of purchase

The Long-Term Care Insurance Partnership Program began in the 1980s to encourage the purchase of private long-term care insurance. It provides an alternative to spending down or transferring assets by forming a partnership between Medicaid and private long-term care insurance.

One of the main benefits of Long-Term Care Partnership plans is that they allow individuals who deplete their long-term care insurance benefits to retain a specified amount of assets and still qualify for Medicaid, provided they meet all other Medicaid eligibility requirements.