Spotlight On Advertiser: Medicare’s Final Rule and You: 2023

Leah Sugar Kari, licensed insurance agent and retired pharmaceutical representative

What is Medicare’s Final Rule for 2023? Medicare vigilantly protects you, the beneficiary, from bait and switch tactics and misleading information about Medicare Advantage, Part D Prescription Drug Plans, and Medicare Supplement Insurance plans. Medicare issued its Final Rule on April 12, 2023. This is a strong step toward improving full disclosure for beneficiaries when discussing plan options and enrolling in coverage. The rule is in effect Oct. 1, 2023, with the goal of ensuring you receive correct and accessible information about Medicare coverage.

This column will touch on the changes most likely to affect you as the beneficiary.

Who must follow the Final Rule? Medicare defines third-party marketing organizations (TPMOs) as “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 beneficiary from becoming aware of a Medicare Advantage plan or plans to making an enrollment decision).”1

How will this affect you? If you are calling for Medicare Advantage and stand-alone Prescription Drug Plan information, your independent agent or broker must advise that the call is being recorded.

A disclaimer text must be read to the caller and your agent or broker, or any entity you call must disclose the number of organizations with whom they hold contracts, and the total number of plans the aforementioned organizations offer. Another regulatory change is that only marketing, sales, and enrollment calls will need to be recorded. The disclosure that the call is being recorded should be announced on all recorded calls.

Medicare requires the Scope of Appointment Form (SOA) to be completed by you to protect you as the beneficiary. Medicare requires this form to be completed by the beneficiary before the agent is allowed to discuss plan benefits or pricing for Medicare Advantage and Prescription Drug Plans. The new ruling requires that this form be completed by you and on file with the agent or broker at least forty-eight hours before the meeting. There are exceptions to this ruling but expect your agent to ask you to complete the form electronically, by a three-way telephone call the agent or broker will start, or on paper at least 48 hours prior to meeting. You complete the form by selecting the topics for which you wish to have information. If the topic is not selected, the agent or broker is not able to discuss that benefit or provide pricing on it. While this form may appear to be daunting, it is Medicare’s protection against “bait and switch” sales tactics and in place to protect you as beneficiary.

What’s in it for you? The disclaimer about not offering every plan helps beneficiaries be aware of the scope of plans the agent, broker, or TPMO has contracts with and directs Medicare beneficiaries to see a complete list of plans offered in their state by accessing or calling Medicare.

The recording of your telephone call provides a record of the initial call to the enrollment. The recording will be safely stored per Medicare’s requirement for 10 years and available for audit if Medicare considers it necessary.

The SOA stops unsolicited marketing. You define what may be discussed in your meeting. Enjoy your well-earned benefit, confident in Medicare’s protections for your well-being. (Third-party marketing organization (TPMO))

Leah Sugar Kari specializes in showing Medicare-eligible people their insurance options. Contact Leah at 520-484-3807 or email [email protected]. (TTY users dial 711.)