CMS Proposes New 2024 Medicare Guidelines

New Proposed Changes announced by the CMS for the 2024 Medicare Guidelines

Summary of Proposed Changes: HERE

Proposed Changes, 957-Page Document: HERE

CMS has released a proposed guideline change for the 2024 Medicare Advantage and Part D programs. There are a host of items that are incredibly pertinent for the Medicare agent on all sorts of potential changes, both to the marketing and sales process.

It’s important to remember that these are just proposed changes.

CMS is going to receive comments from insurance carriers and then make a final rule that we all have to work with. NAHU, which is an organization working to protect the agents place in the Medicare sales process has put together a great summary of this proposed rule. Additionally, if you’re interested in reading the entire 957-page document, it’s available here.

Now let’s go through some of the most interesting pieces from this new proposed rule:

Is This the End of the Lead Aggregators?

CMS takes specific aim at lead generation in this proposed rule in a number of areas, but most specifically at the selling and reselling of beneficiary contact information.

Some of the commentators that have written about this proposed rule have said that this will result in a ban on lead sales. This really isn’t completely the case.

Here are the lead generation activities that this won’t affect:

• As a Medicare agent, you can still send out direct mail leads that have your name or your agency’s name on it.
• You can still do local TV commercials for your agency with your contact information and phone number.
• You can create a Facebook campaign routing consumers to your business page.
• Your upline. Someone like Neishloss and Fleming can generate leads through digital platforms and make them available to you.

Here’s what this could eliminate: Companies doing broad spectrum TV and Internet advertising, and then trying to resell those leads to 50 agents at a time.

This could potentially improve the environment for you: The independent Medicare agent.

Scope of Appointment Changes

Now, there are a lot of items in the proposed rule that touch on scope of appointment. Let’s hit each of these one at a time.

CMS adjusted their guidelines a few years ago and began to allow agents to collect contact information and a scope of appointment forms at educational events.

Based on their review of complaints, CMS is considering prohibiting agents from collecting SOAs at educational events, which could reduce their effectiveness for you in generating sales from that.

Next, CMS is going to be prohibiting sales appointments to occur until at least 48 hours after the completion of the SOA form. This could have a really big impact on agents who relied upon getting the SOA at the home at the beginning of the appointment.

As you know, the rule is CMS would like the scope filled out 48 hours ahead of time unless there was a reason why this couldn’t happen. That ambiguity and that exception is going to be gone. This will complicate your sales process and possibly serve as a barrier for enrollment to individuals who wait till the end of the month.

Lastly, CMS is proposing to limit the validity of an SOA for six months. This shouldn’t pose too much of a problem for agents, as many of you are simply getting that scope of appointment form during the process of sales presentation as opposed to coming back to those folks six months down the line.

Sales Appointments – Do’s and Don’ts

CMS is looking to make significant changes very specifically to the pre-enrollment checklist that is reviewed with the consumer prior to the completion of the application or the sale. The first element CMS wants to add is an effect on current coverage element. This would make sure that during the sales process with the pre-enrollment checklist that agents reviewed exactly how the new plan would impact enrollment in an existing MA Medigap or TRICARE plan.

CMS feels like this is a hole in the current process and it results in a high volume of consumer complaints. This would be a requirement for both in-person and telephonic sales.

CMS explained in detail about how they feel telephonic agents are not informing consumers about a host of items. Some of the examples they cited: providers that were out of network, drugs that are not covered, inaccurate costs, and impact to existing coverage.

If you’re concerned about these proposed 2024 Medicare guidelines, you may be asking yourself, what can you do? We recommend that you reach out to your local neighborhood NAHU chapter, raise your concerns, and let the only advocacy group that works to protect your place in the market go to work for you.

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