MA Marketing Compliance Question

[Winter_123]

What are the rules of engagement here:

Let's suppose you have a valid appointment to go by and see a prospect to discuss an MA plan. By "valid", let's assume your means of contact with them was compliant, you have their written or recorded approval to come by, etc. etc.

You are showing them plans by carrier XYZ and these are the same plans discussed when you got their approval to come by so the expectation is that is what you will be discussing. So far, so good.

Now, as is often/usually the case, the prospect says "how does that compare with plan ABC that my sister says I should get or that some other agent sent me."

We run into this all the time and obviously we all navigage it based on our skills, knowledge whatever. However, what we may or may not be doing and what may nor may not make sense may or may not be what CMS allows because they are nutcases - so I am looking to stay grounded here.

Suppose further, to keep it simple, you are not appointed with the other carrier/plan but obviously the elements of that plan are known to you and in fact the basic elements are available (as with all plans) on the medicare.gov site.

Assuming that you do not disparage the other carrier or plan inappropriately, and just stick to the summary of benefits, is it your view that you are free to just point out the details of differences between the two plans or is it your view that CMS says you can only talk about your plan and they have to go off and figure it out themselves.

What sayeth thee. CMS is such a nutcase where they always want information presented in a way that can help clients make real comparisons then they have a whole set of rules to keep you from doing that. What is the best understanding here of what is compliant.

 

[alphawave2k]

What are the rules of engagement here:

Let's suppose you have a valid appointment to go by and see a prospect to discuss an MA plan. By "valid", let's assume your means of contact with them was compliant, you have their written or recorded approval to come by, etc. etc.

You are showing them plans by carrier XYZ and these are the same plans discussed when you got their approval to come by so the expectation is that is what you will be discussing. So far, so good.

Now, as is often/usually the case, the prospect says "how does that compare with plan ABC that my sister says I should get or that some other agent sent me."

We run into this all the time and obviously we all navigage it based on our skills, knowledge whatever. However, what we may or may not be doing and may nor may not make sense may or may not be what CMS says because they are nutcases so I am looking to stay grounded here.

Suppose further, to keep it simple, you are not appointed with the other carrier/plan but obviously the elements of that plan are known to you and in fact the basic elements are available (as with all plans) on the medicare.gov site.

Assuming that you do not disparate the other carrier or plan inappropriately, and just stick to summary of benefits, is it your view that you are free to just point out the details of differences between the two plans or is it your view that CMS says you can only talk about your plan and they have to go off and figure it out themselves.

What sayeth thee. CMS is such a nutcase where they always want information presented in a way that can help clients make real comparisons then they have a whole set of rules to keep you from doing that. What is the best understanding here of what is compliant.

I may not be the best person to answer this, but WTH, here it goes. To me, the SOA form is generic and should be applicable to any company's MAPD, or PDP plan whatever the case...many companies accept each other's SOA forms. If you have a SOA to discuss one company's plan and another company's plan comes up you are fine to compare the 2, specially if you are comparing apples to apples, i.e. looking at the Summary of Benefits and going down line by line to compare the benefits.

IMHO, you wouldn't be disparaging the company if you actually look at the Summary of Benefits and it's obvious one company wants to charge a $50 monthly premium, and have the client be exposed to $6000 max OOP, vs a $0 premium and $3800 max OOP, for instance.
There might be a trade off, such as one being a PPO, vs the other being an HMO and having a PCP which is not on the list, or a facility they would like to get treatment at is not in the Directory, or perhaps the drugs being classified on a different tier level, impacting the copayments.
If you clearly and accurately explain the pros and cons to the client, they can make their decision based on the information you're providing them.
I've had people opt to go with the higher cost plan, and I'm still not sure why they make that choice. Human nature defies logic when someone says they want to save money, but their decisions don't support that statement.

 

[Winter_123]

I may not be the best person to answer this, but WTH, here it goes. To me, the SOA form is generic and should be applicable to any company's MAPD, or PDP plan whatever the case...many companies accept each other's SOA forms. If you have a SOA to discuss one company's plan and another company's plan comes up you are fine to compare the 2, specially if you are comparing apples to apples, i.e. looking at the Summary of Benefits and going down line by line to compare the benefits.

IMHO, you wouldn't be disparaging the company if you actually look at the Summary of Benefits and it's obvious one company wants to charge a $50 monthly premium, and have the client be exposed to $6000 max OOP, vs a $0 premium and $3800 max OOP, for instance.
There might be a trade off, such as one being a PPO, vs the other being an HMO and having a PCP which is not on the list, or a facility they would like to get treatment at is not in the Directory, or perhaps the drugs being classified on a different tier level, impacting the copayments.
If you clearly and accurately explain the pros and cons to the client, they can make their decision based on the information you're providing them.
I've had people opt to go with the higher cost plan, and I'm still not sure why they make that choice. Human nature defies logic when someone says they want to save money, but their decisions don't support that statement.

Ahh. I don't know. That is actually a little different scenario than what I posed. Last I knew, CMS was down on you showing two different plans at the same appointment where the prospect could choose either and you stand ready to sell either. Even though it is nuts, I think that is not compliant.

The scenario I proposed is one where I intend to show and sell only one and the prospect asks what the differences are between that and another plan and where I am not appointed with that other plan and do not intend to be. I am thinking that I am compliant if I point out any differences that are simply a matter of public record on the medicare.gov summary of benefits (in other words I am nor representing that I am appointed to speak for that plan) and where it is clear that I am not intending to switch a person from one plan over to another if they like the other. I think those are key elements that keep me on the safe side but, as stated, CMS is always on the rag about something so I am just asking for opinions here.

 

[alphawave2k]

Ahh. I don't know. That is actually a little different scenario than what I posed. Last I knew, CMS was down on you showing two different plans at the same appointment where the prospect could choose either and you stand ready to sell either. Even though it is nuts, I think that is not compliant.

The scenario I proposed is one where I intend to show and sell only one and the prospect asks what the differences are between that and another plan and where I am not appointed with that other plan and do not intend to be. I am thinking that I am compliant if I point out any differences that are simply a matter of public record on the medicare.gov summary of benefits (in other words I am nor representing that I am appointed to speak for that plan) and where it is clear that I am not intending to switch a person from one plan over to another if they like the other. I think those are key elements that keep me on the safe side but, as stated, CMS is always on the rag about something so I am just asking for opinions here.

I see what you're saying, but whether you rep only 1 plan and compare it to the one they have, showing one is better offering a clear choice (the one you came in intending to sell), vs repping the 2 companies and having the client choose from the 2 or 3 or however many you want to carry around, how can any of that be in violation? Aren't we suppose to help the client make the best choice for them, and isn't that what the spirit or intent of the regulation aimed at?
Honestly, when we say CMS is nuts doesn't this add another nail on that coffin?

 

[VaDwayne]

What are the rules of engagement here:

Let's suppose you have a valid appointment to go by and see a prospect to discuss an MA plan. By "valid", let's assume your means of contact with them was compliant, you have their written or recorded approval to come by, etc. etc.

You are showing them plans by carrier XYZ and these are the same plans discussed when you got their approval to come by so the expectation is that is what you will be discussing. So far, so good.

Now, as is often/usually the case, the prospect says "how does that compare with plan ABC that my sister says I should get or that some other agent sent me."

We run into this all the time and obviously we all navigage it based on our skills, knowledge whatever. However, what we may or may not be doing and what may nor may not make sense may or may not be what CMS allows because they are nutcases - so I am looking to stay grounded here.

Suppose further, to keep it simple, you are not appointed with the other carrier/plan but obviously the elements of that plan are known to you and in fact the basic elements are available (as with all plans) on the medicare.gov site.

Assuming that you do not disparage the other carrier or plan inappropriately, and just stick to the summary of benefits, is it your view that you are free to just point out the details of differences between the two plans or is it your view that CMS says you can only talk about your plan and they have to go off and figure it out themselves.

What sayeth thee. CMS is such a nutcase where they always want information presented in a way that can help clients make real comparisons then they have a whole set of rules to keep you from doing that. What is the best understanding here of what is compliant.

I believe that you will be fine if you are discussing another MA or MAPD product. I would say the only issue you have is if they want to discuss a MedSupp or other medical coveage, or any non-health product.

I think you would be in compliance if you print the other companies information directly off of their website. I don't do a ton of MA's, so this is definitely an opinion.

 

[Winter_123]

I would say the only issue you have is if they want to discuss a MedSupp or other medical coveage, or any non-health product.

Actually a med supp discussion is allowable if they have signed the scope of appointment or recorded approval for a medicare advantage appointment. Non medicare product discussions not allowed.

 

[GreenSky]

The SOA form allows you to discuss anything that is dealing with Medicare health. Including MA, MAPD, Supplements. You can also check the box to discuss PDP plans as well.

I compare multiple products constantly and use a generic SOA.

This is pretty much common knowledge among those of us in the business for any length of time or if an agent has made up for the lack of years by really learning Medicare.

Rick

 

[VaDwayne]

Actually a med supp discussion is allowable if they have signed the scope of appointment or recorded approval for a medicare advantage appointment. Non medicare product discussions not allowed.

Thanks for the correction.

 

[retread]

Ahh. I don't know. That is actually a little different scenario than what I posed. Last I knew, CMS was down on you showing two different plans at the same appointment where the prospect could choose either and you stand ready to sell either. Even though it is nuts, I think that is not compliant.

The scenario I proposed is one where I intend to show and sell only one and the prospect asks what the differences are between that and another plan and where I am not appointed with that other plan and do not intend to be. I am thinking that I am compliant if I point out any differences that are simply a matter of public record on the medicare.gov summary of benefits (in other words I am nor representing that I am appointed to speak for that plan) and where it is clear that I am not intending to switch a person from one plan over to another if they like the other. I think those are key elements that keep me on the safe side but, as stated, CMS is always on the rag about something so I am just asking for opinions here.

I am with you on this, Winter. I, too have reduced my choice of carrier to one that dominates my area and let the others die on the vine.

Your issue: If a client asks me a question about a competitor, I answer it. I don't go out of my way to illustrate the competition's product, I just answer the question posed. Usually this situation does not come up in most of my presentations, but on occasion does. It is arising less and less due to the requirements of a verbatim script just thrust upon me the last month of the AEP.

A note: My presentations have now been reduced to reciting a company provided and mandated script.... I don't know about other companies, but I expect they will all require a mechanical script before long. CMS is no doubt behind this. Perhaps others might voice their commentary....

 

[Josh]

To answer your question, as long as you're using CMS approved marketing materials (like medicare.gov, SOB from the other plan, etc) and trying to make as fair and accurate a comparison as possible between the plans (actually going over more than a few benefits) you're going to be safe. There is no exact language for what is considered an inaccurate comparison and what is not, but you'll want to go the extra mile and if they're only asking about inpatient copay comparisons you'll want to throw in the differences between some of the less rich benefits like maybe the SNF, etc. Odds are they wont have the SOB of the other plan, but if they do that'd be ideal. I try to keep in mind the benefits of any of the major players (either by membership or marketing) so when they ask I know OOP, inpatient hospitalization, PCP/Specialist, SNF, part b covered drug coverage and a handful of others off the top of my head and that's been way helpful.

A note: My presentations have now been reduced to reciting a company provided and mandated script.... I don't know about other companies, but I expect they will all require a mechanical script before long. CMS is no doubt behind this. Perhaps others might voice their commentary....

I think they might very well skip the mechanical script and go right to doing the enrollments themselves without any agent involvement.