1. Module 4: Communications and Marketing Rules for Medicare 5. Training Roadmap: Module 4
Advantage and Part D Plans New rules for marketing 2024 products
Applicability of rules concerning marketing and communications
2. Navigation Instructions Marketing Representatives: agents/brokers and third party marketing organizations
Key terms and general background information
Regulation of communications activities and materials
3. Terms and Conditions Marketing communications – contacting beneficiaries
This training program is protected under United States Copyright laws, 17 U.S.C.A. §101, et seq. and Rules related to sales and educational events
international treaties. Except as provided below, the training program may not be reproduced (in whole Marketing at individual appointments
or in part) in hard paper copy, electronically, or posted on any web site or intranet without the prior Use of social media to market
written consent of AHIP. Any AHIP member company in good standing sponsoring a Medicare Required practices
Advantage or Part D plan may reproduce the training program for the limited purpose of providing Accessing and using certain plan materials
training and education to the company’s own employees and contractors on the subject matter Plan ratings and call recordings
contained in the training program. Employees or contractors participating in such training may not Prohibited activities
further reproduce (in whole or in part) the training program. No changes of any kind may be made to Marketing during the open enrollment period
the training program and any reproduction must include AHIP's copyright notice. This limited license is Marketing in healthcare settings
terminable at will by AHIP. Plan oversight and enforcement of marketing requirements
The training program is intended to provide guidance only in identifying factors for consideration in the Marketing Representative Compensation
basic rules and regulations governing coverage, eligibility, marketing, and enrollment for Medicare, Frequently asked questions
Medicare supplement insurance, Medicare health plans, and Part D prescription drug plans and is not
intended as legal advice. While all reasonable efforts have been made to ensure the accuracy of the
information contained in this document, AHIP shall not be liable for reliance by any individual upon the 6. New for Marketing of 2024 Products (effective September 30, 2023)
contents of the training program. A Scope of Appointment must be obtained 48 hours before all marketing appointments, not just
when “practicable.” There are two exceptions to this rule – one for unexpected in-person meetings
initiated by the beneficiary and one for when the meeting request occurs during the last four days of
4. Learning Objectives the relevant election period.
After reviewing “Module 4: Communications and Marketing Rules for Medicare Advantage and Part Requests to be contacted, e.g., business reply cards and scope of appointments, are only valid for
D Plans” you will be able to explain: twelve months.
o What are communications Marketing events may no longer be held directly following educational events.
o What activities constitute marketing and what materials are marketing materials Scope of appointment forms may no longer be collected during educational events and future sales
o The special rules for marketing Medicare health plans and Part D plans appointments may not be set up.
o Rules for making marketing appointments The obligation to record all calls with beneficiaries has been revised to only apply to sales,
o Prohibited marketing and communications practices marketing, and enrollment calls.
o Permitted promotional and marketing activities The TPMO disclaimer has been updated to include references to State Health Insurance Programs
o The difference between educational and marketing events (SHIPS) and to require disclosure about the number of plans the TPMO represents.
o Rules regarding agent compensation CMS has specified a list of topics that must be addressed with a beneficiary before enrollment.
o Plan enforcement of the marketing rules and potential penalties
7. Title Page – Applicability of Rules Concerning Marketing and
Communications
1 2
, 8. Medicare Marketing and Communications Rules o the requirement that a marketing representative must pass an annual test, although the
The Medicare marketing and communications rules apply to the following types of Medicare health requirement for annual training does apply
plans and Part D plans:
Plans offering employer group health plans are not required to submit marketing materials specific only
Medicare Advantage (MA) only plans to those employer plans to CMS at the time of use. However, CMS may request and review copies if
Medicare Advantage Prescription Drug (MA-PD) plans employee complaints occur or for any other reason to ensure the information accurately and adequately
Prescription Drug Plans (PDPs) informs beneficiaries about their rights and obligations under the plan.
Section 1876 Cost plans
Medicare-Medicaid Plans (MMPs)
o For MMPs, marketing requirements may be modified by state-specific requirements. 11. Title Page – Marketing Representatives: Agents/Brokers and Third
Each state in which MMPs are offered has state-specific marketing guidelines and CMS-
Party Marketing Organizations
approved model documents. Those guidelines and documents can be accessed at
https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid -
Coordination/Medicare-Medicaid-Coordination- 12. Third Party Marketing Organizations and “Marketing
Office/FinancialAlignmentInitiative/MMPInformationandGuidance/MMPMarketingInfor Representatives”
mationandResources.html Third Party Marketing Organizations (TPMOs) are organizations and individuals, including
independent agents and brokers, who are compensated to perform lead generation, marketing,
sales, and enrollment related functions as a part of the chain of enrollment (the steps taken by a
9. Applicability of Medicare Communications and Marketing beneficiary from becoming aware of an MA or Part D plan or plans to making an enrollment
decision). TPMOs may directly contract with the plan sponsor, may be a downstream contractor of a
Rules to Marketing Representatives
Plan Sponsor, or may be a related entity of the Plan Sponsor (referred to as first tier, downstream or
Plan marketing representatives are subject to the same requirements related to marketing and
related entities or FDRs). However, they may also be entities that are not FDRs but provide services
communications as the plans. Plans are responsible for ensuring compliance with Medicare rules by
to an MA plan or an MA plan’s FDR.
their marketing representatives, such as the need for annual training.
Independent agents and brokers are those that are not directly employed by a plan and
Plan marketing representatives include: those that market for more than one plan.
Agents and brokers employed by the plan are not TPMOs.
individuals employed by a plan
In this training, we refer to TPMOs and employed agents and brokers as “Marketing
individuals or entities under contract to the plan through a direct or downstream contract.
Representatives.”
o This would include brokers and agents (contracting directly the plan or through an
agency or other entity), Field marketing organizations (FMOs), agencies, general agents
(GAs), or other Third Party Marketing Organizations (TPMO).
13. TPMOs: Example
Amazing Agency contracts through an FMO to market and enroll members in 10 different Medicare
Advantage organizations. Amazing Agency has contracted with Internet Innovations to advertise the
10. Applicability of Medicare Communications and Marketing Rules
agency, its products and provide sales leads to the agency. The FMO, Amazing Agency, and Internet
when Marketing to Employer/Union Groups Innovations are all TPMOs.
Marketing representatives and Plans must follow all marketing rules and guidelines when marketing
employer group health plans except the following:
o the prohibition against unsolicited contacts 14. Requirements to Act as Agents and Brokers
o the prohibition against cross-selling other products Plan sponsors must contract with or employ agents and brokers that are licensed by the state if they
o the requirement to obtain prior documentation of the scope of an appointment conduct the relevant activities in that state.
o the prohibition against providing meals at marketing events Agents and brokers must be appointed by the plan if required under State law.
o the pre-enrollment checklist requirement MA and Part D plans are required by law to ensure that all employed and contracted agents and
o marketing representative compensation requirements brokers complete training at least annually that includes all content specified by CMS.
o They also must pass a written test each year that demonstrates thorough familiarity with
both the Medicare program and the products they are selling.
3 4
Advantage and Part D Plans New rules for marketing 2024 products
Applicability of rules concerning marketing and communications
2. Navigation Instructions Marketing Representatives: agents/brokers and third party marketing organizations
Key terms and general background information
Regulation of communications activities and materials
3. Terms and Conditions Marketing communications – contacting beneficiaries
This training program is protected under United States Copyright laws, 17 U.S.C.A. §101, et seq. and Rules related to sales and educational events
international treaties. Except as provided below, the training program may not be reproduced (in whole Marketing at individual appointments
or in part) in hard paper copy, electronically, or posted on any web site or intranet without the prior Use of social media to market
written consent of AHIP. Any AHIP member company in good standing sponsoring a Medicare Required practices
Advantage or Part D plan may reproduce the training program for the limited purpose of providing Accessing and using certain plan materials
training and education to the company’s own employees and contractors on the subject matter Plan ratings and call recordings
contained in the training program. Employees or contractors participating in such training may not Prohibited activities
further reproduce (in whole or in part) the training program. No changes of any kind may be made to Marketing during the open enrollment period
the training program and any reproduction must include AHIP's copyright notice. This limited license is Marketing in healthcare settings
terminable at will by AHIP. Plan oversight and enforcement of marketing requirements
The training program is intended to provide guidance only in identifying factors for consideration in the Marketing Representative Compensation
basic rules and regulations governing coverage, eligibility, marketing, and enrollment for Medicare, Frequently asked questions
Medicare supplement insurance, Medicare health plans, and Part D prescription drug plans and is not
intended as legal advice. While all reasonable efforts have been made to ensure the accuracy of the
information contained in this document, AHIP shall not be liable for reliance by any individual upon the 6. New for Marketing of 2024 Products (effective September 30, 2023)
contents of the training program. A Scope of Appointment must be obtained 48 hours before all marketing appointments, not just
when “practicable.” There are two exceptions to this rule – one for unexpected in-person meetings
initiated by the beneficiary and one for when the meeting request occurs during the last four days of
4. Learning Objectives the relevant election period.
After reviewing “Module 4: Communications and Marketing Rules for Medicare Advantage and Part Requests to be contacted, e.g., business reply cards and scope of appointments, are only valid for
D Plans” you will be able to explain: twelve months.
o What are communications Marketing events may no longer be held directly following educational events.
o What activities constitute marketing and what materials are marketing materials Scope of appointment forms may no longer be collected during educational events and future sales
o The special rules for marketing Medicare health plans and Part D plans appointments may not be set up.
o Rules for making marketing appointments The obligation to record all calls with beneficiaries has been revised to only apply to sales,
o Prohibited marketing and communications practices marketing, and enrollment calls.
o Permitted promotional and marketing activities The TPMO disclaimer has been updated to include references to State Health Insurance Programs
o The difference between educational and marketing events (SHIPS) and to require disclosure about the number of plans the TPMO represents.
o Rules regarding agent compensation CMS has specified a list of topics that must be addressed with a beneficiary before enrollment.
o Plan enforcement of the marketing rules and potential penalties
7. Title Page – Applicability of Rules Concerning Marketing and
Communications
1 2
, 8. Medicare Marketing and Communications Rules o the requirement that a marketing representative must pass an annual test, although the
The Medicare marketing and communications rules apply to the following types of Medicare health requirement for annual training does apply
plans and Part D plans:
Plans offering employer group health plans are not required to submit marketing materials specific only
Medicare Advantage (MA) only plans to those employer plans to CMS at the time of use. However, CMS may request and review copies if
Medicare Advantage Prescription Drug (MA-PD) plans employee complaints occur or for any other reason to ensure the information accurately and adequately
Prescription Drug Plans (PDPs) informs beneficiaries about their rights and obligations under the plan.
Section 1876 Cost plans
Medicare-Medicaid Plans (MMPs)
o For MMPs, marketing requirements may be modified by state-specific requirements. 11. Title Page – Marketing Representatives: Agents/Brokers and Third
Each state in which MMPs are offered has state-specific marketing guidelines and CMS-
Party Marketing Organizations
approved model documents. Those guidelines and documents can be accessed at
https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid -
Coordination/Medicare-Medicaid-Coordination- 12. Third Party Marketing Organizations and “Marketing
Office/FinancialAlignmentInitiative/MMPInformationandGuidance/MMPMarketingInfor Representatives”
mationandResources.html Third Party Marketing Organizations (TPMOs) are organizations and individuals, including
independent agents and brokers, who are compensated to perform lead generation, marketing,
sales, and enrollment related functions as a part of the chain of enrollment (the steps taken by a
9. Applicability of Medicare Communications and Marketing beneficiary from becoming aware of an MA or Part D plan or plans to making an enrollment
decision). TPMOs may directly contract with the plan sponsor, may be a downstream contractor of a
Rules to Marketing Representatives
Plan Sponsor, or may be a related entity of the Plan Sponsor (referred to as first tier, downstream or
Plan marketing representatives are subject to the same requirements related to marketing and
related entities or FDRs). However, they may also be entities that are not FDRs but provide services
communications as the plans. Plans are responsible for ensuring compliance with Medicare rules by
to an MA plan or an MA plan’s FDR.
their marketing representatives, such as the need for annual training.
Independent agents and brokers are those that are not directly employed by a plan and
Plan marketing representatives include: those that market for more than one plan.
Agents and brokers employed by the plan are not TPMOs.
individuals employed by a plan
In this training, we refer to TPMOs and employed agents and brokers as “Marketing
individuals or entities under contract to the plan through a direct or downstream contract.
Representatives.”
o This would include brokers and agents (contracting directly the plan or through an
agency or other entity), Field marketing organizations (FMOs), agencies, general agents
(GAs), or other Third Party Marketing Organizations (TPMO).
13. TPMOs: Example
Amazing Agency contracts through an FMO to market and enroll members in 10 different Medicare
Advantage organizations. Amazing Agency has contracted with Internet Innovations to advertise the
10. Applicability of Medicare Communications and Marketing Rules
agency, its products and provide sales leads to the agency. The FMO, Amazing Agency, and Internet
when Marketing to Employer/Union Groups Innovations are all TPMOs.
Marketing representatives and Plans must follow all marketing rules and guidelines when marketing
employer group health plans except the following:
o the prohibition against unsolicited contacts 14. Requirements to Act as Agents and Brokers
o the prohibition against cross-selling other products Plan sponsors must contract with or employ agents and brokers that are licensed by the state if they
o the requirement to obtain prior documentation of the scope of an appointment conduct the relevant activities in that state.
o the prohibition against providing meals at marketing events Agents and brokers must be appointed by the plan if required under State law.
o the pre-enrollment checklist requirement MA and Part D plans are required by law to ensure that all employed and contracted agents and
o marketing representative compensation requirements brokers complete training at least annually that includes all content specified by CMS.
o They also must pass a written test each year that demonstrates thorough familiarity with
both the Medicare program and the products they are selling.
3 4
