CMS Spooks MA Plans With Warning About Secret Shopping, Enhanced Monitoring

November 3

If Medicare Advantage organizations and Prescription Drug Plans (PDPs) this open enrollment season have the haunting feeling they’re being watched, it’s because they are. After implementing new rules aimed at better protecting beneficiaries from confusing and misleading Medicare marketing, CMS in October issued two memos informing plans that they’ve done some digging into recent marketing activities and they don’t like what they’ve seen so far.

CMS has reported that marketing-related complaints more than doubled between 2020 and 2021 — which it largely attributed to the actions of third-party marketing organizations (TPMOs) — and has expressed particular concern with third-party marketers’ claims that some benefits are widely available to seniors when they vary by service area. To address these concerns, CMS made key changes this year, such as requiring TPMOs to use a standardized disclaimer that they do not offer every plan available in the area, clarifying that independent agents and brokers qualify as TPMOs, and stipulating that plans in their contracts with TPMOs require full recordings of sales calls with beneficiaries.

0 Comments

Radar on Medicare Advantage

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.