What Medicare Marketing Materials Are Really Saying and How, When, and Where They Can Say It

2019 Medicare Marketing Guidelines

Medicare Marketing Guidelines mean there are rules in place to protect you

When you read, see, or hear advertisements for various products and services, you have more than likely noticed that in some cases, the benefits can be exaggerated just a bit. Yet, while this is oftentimes anticipated – and possibly even expected – with certain items such as those that are touted on late night informercials, when it comes to Medicare insurance products, there are some strict guidelines that must be followed.

This includes Medicare Advantage (MA) plans (also referred to as Medicare Part C) and Medicare Part D prescription drug plans – both of which are offered through private insurance companies that have been approved by Medicare to sell such plans.

Prohibited Statements and Terminology in Medicare Product Advertising

As outlined by the most recent (July 2018) Medicare Communications and Marketing Guidelines, there are various words and phrases that can and cannot be made. For instance, plans and / or plan sponsors are strictly prohibited from offering communications that are deemed to be “materially inaccurate, misleading, or that otherwise make misrepresentations or that could confuse beneficiaries.”

Medicare Part D Prescription Drug Plan and Medicare Advantage (Part D) Plan Guidelines

With regard to Medicare Part D prescription drug plans, as well as Medicare Advantage plans, the following types of communication are prohibited. Therefore, these plans and plan sponsors may not do the following in their marketing and advertising materials:

  • State that they will not dis-enroll an individual if he or she does not make their premium payment;
  • Use the word “FREE” for describing a plan that has a zero dollar premium, and likewise with plans that may include reduction in premium costs, cost sharing, reduced deductibles, low income subsidies, and / or cost sharing for those who are dually eligible for both Medicare and Medicaid;
  • Claim that the plan and / or the insurer has been endorsed or recommended by Medicare, and / or by the Centers for Medicare and Medicaid Services (CMS), and the U.S. Department of Health and Human Services;
  • Use qualified superlatives, pejoratives, or unsubstantiated absolute superlatives in the context of the plan description. (However, it is permitted for plans or sponsors to use unsubstantiated absolute and / or qualified superlatives in taglines and / or logos for Medicare Part D plan marketing.)

Medicare Part D prescription drug plan sponsors and Medicare Advantage plans are, however, allowed to do the following as it relates to communications:

  • Use the term “FREE” as it relates to mandatory supplemental and preventive benefits that are provided at a zero dollar cost sharing for all of the enrollees;
  • Use the term “Medicare approved” in describing their services and / or benefits;
  • State that the Medicare Advantage plan or Medicare Part D plan sponsor is approved to participate in Medicare’s program and / or that it is contracted to administer Medicare benefits.

Similarly, Medicare Advantage plans (that are not considered to be Medicare Special Needs Plans) are not permitted to do the following as it pertains to marketing and advertising:

  • Imply that Medicare Advantage plans are designed for individuals who are dually eligible for both Medicare and Medicaid coverage;
  • Target their marketing and advertising efforts exclusively to individuals who are deemed as “dual eligibles”;
    Claim that the insurance plan carrier has a relationship with the state in terms of coordinating Medicaid services.

Medicare Medical Savings Accounts (MSAs)

Similar to with Medicare Part D and Medicare Advantage plans, it is not permitted for Medicare Medical Savings Accounts (MSAs) to imply that they work as a Medicare Supplement insurance policy.

Medicare Supplement and Medicare Medical Savings Accounts are two entirely different types of Medicare coverage. Likewise, Medicare Supplement and Medicare Advantage are also different types of plans, and those who receive their Medicare health care benefits through a Medicare Advantage plan may not also enroll in Medicare Supplement coverage.

Medicare Plan Product Testimonials and / or Endorsements

There may be times when a celebrity, a spokesperson, or some other known individual provides a testimonial or an endorsement which states how – and how well – a particular product or service worked for them. If this is the case with Medicare Part D and / or Medicare Advantage coverage, such testimonials or endorsements are required to abide by the following requirements:

  • The provider of the testimonial or the endorsement must identify the Medicare Advantage plan’s and / or Medicare Part D sponsor’s product or company by name;
  • The plan or plan sponsor must be able to back up any of the claims that are made by the individual in the endorsement or testimonial;
  • If a celebrity is paid to portray either a real or a fictitious situation, the ad must clearly state that it is a portrayal from a paid actor or actress;
  • If a Medicare enrollee is either promoting or endorsing a particular product, he or she must actually be enrolled in the Medicare Part D or Medicare Advantage plan;
  • If any individual is paid to promote or endorse a plan, the ad must clearly state that it is a paid endorsement or testimonial. (This is the case for anyone, and not just with a paid celebrity endorser).

It is also important to note that the re-using of any comments or content from social media websites such as Twitter or Facebook that promote a Medicare Part D or a Medicare Advantage plan is still considered to be a product testimonial or endorsement, and therefore is required to adhere to these communications guidelines.

Timing of Medicare Plan D and Medicare Advantage Marketing and Communication

When the marketing of Medicare plans such as Part D and Part C occur is also dictated by the Medicare Communications and Marketing Guidelines. According to the most updated of these rules, Medicare Advantage and Medicare Part D plans are not allowed to market for an upcoming plan year prior to October 1st.

However, these plans are allowed to market concurrently the upcoming year’s plans along with the current year’s plans beginning on October 1st of a given year, provided that the accompanying marketing materials make it clear which of the plan years is being promoted.

Who Can Medicare Part C and D Plans Market To?

Who receives promotional material from Medicare Advantage and Medicare Part D sponsors is also a component of marketing that must be adhered to – especially as it pertains to unsolicited advertisements.

In this case, plan sponsors for Medicare Advantage and Medicare prescription drug plans may not use door-to-door solicitation. This includes leaving flyers or other information at a prospect’s door or in their mailbox.

Similarly, representatives from these types of plans may not approach potential plan enrollees in common or public areas, such as on the sidewalk or in a parking lot, or in the lobby or the hallway of a public building.

In addition, it is also prohibited for Medicare Part C and Part D plan sponsors to use the telephone for unsolicited calls. This includes leaving a voice mail message for a potential plan enrollee.

It is important to note that there are some exceptions to the rules pertaining to unsolicited marketing for Medicare plans. These include the approval to leave materials at the home of a potential enrollee if an agent or broker had a pre-scheduled appointment with an individual, but that individual did not show up for the appointment.

Likewise, if a potential Medicare plan enrollee provides permissions to be contacted, a Medicare plan agent or broker may do so – as long as this contact is event-specific, and that the agent or broker does not treat the permission to contact the individual as an open-ended invitation for any future contact.

There are also certain times or situations where it is permissible to make an unsolicited direct contact with a potential Medicare Part D or Medicare Advantage enrollee. For instance, sending materials via conventional mail is ok, as is sending information via print media, such as in advertisements.

In addition, a potential enrollee may also be contacted – even if this contact is unsolicited – through email messages, provided that all of the emails that are sent to the individual contain a function for opting out of any future communications.

What to Do If You Need More Information on a Medicare Advantage or Medicare Part D Plan?

Medicare’s benefits can be somewhat confusing. There are many different options that you can choose from, as well as ancillary coverage such as Medicare Supplement insurance. Because of that, it is likely that you may have some additional questions before you initially enroll, or before you make any changes to your current Medicare coverage.
If this is the case, it is typically best to talk with a local Medicare insurance professional who specializes in this type of coverage. That way, he or she can ensure that all of your questions are answered before you move forward. There is also unbiased information that you can find on the Medicare website, which can be accessed by going to www.Medicare.gov.

Sources

Medicare Communications and Marketing Guidelines (MCMG). July 20, 2018. (https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/CY2019_Medicare_Communications_and_Marketing_Guidelines.pdf)