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As the Medicare Annual Election Period gets underway, CMS is warning Medicare Advantage organizations and Prescription Drug Plan sponsors that it will be closely monitoring marketing activities during and beyond the AEP, including through “secret shopping” activities. Given increasing concerns about the marketing practices of all entities, including third-party marketing organizations, CMS has engaged in secret shopping by calling numbers associated with television advertisements, mailings, newspaper ads and internet searches and discovered that some agents are not complying with current rules and are “unduly pressuring beneficiaries, as well as failing to provide accurate or enough information to assist a beneficiary in making an informed enrollment decision,” according to an Oct. 19 memo. However, starting Jan. 1, 2023, television advertisements will no longer qualify for CMS’s “File and Use” framework that allows materials submitted to be distributed five days after submission. Moreover, the agency will review all previously submitted television ads to confirm that materials meet CMS requirements and may take compliance action against plans that use “CMS-disapproved advertisements.” In addition, the agency during the AEP and into the new plan year will enhance its oversight of plan marketing in numerous ways, such as through enhanced review of select marketing materials submitted under File and Use criteria, targeted oversight of MAOs and Part D sponsors with higher or increasing rates of complaints during the AEP, and review of recordings of agent and broker calls with potential enrollees, CMS said.

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Lauren Flynn Kelly

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.

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