2024 Medicare Final Rule Updates

The Medicare Final Rule 2024 introduces a series of significant changes that will directly affect insurance agents, their marketing strategies, and their interactions with beneficiaries. To help insurance agents adapt to these new regulations, we’ve compiled a detailed overview of some of the major changes:

1. Requiring 48 hours between a Scope of Appointment and an agent meeting with a beneficiary, with exceptions for beneficiary-initiated walk-ins and the end of a valid enrollment period.
2. Modifying the TPMO disclaimer to add SHIPs as an option for beneficiaries to obtain additional help; modifying the TPMO disclaimer to state the number of organizations represented by the TPMO as well as the number of plans.
3. Prohibiting marketing of benefits in a service area where those benefits are not available, unless unavoidable because of use of local or regional media that covers the service area(s).
4. Requiring agents to explain the effect of an enrollee’s enrollment choice on their current coverage whenever the enrollee makes an enrollment decision.
5. Limiting the time that a sales agent can call a potential enrollee to no more than 12 months following the date that the enrollee first asked for information. New permission to contact will be required to call the beneficiary after the 12-month window has ended.
6. Limiting the requirement to record calls between third-party marketing organizations (TPMOs) and beneficiaries to marketing (sales) and enrollment calls.
7. Prohibiting a marketing event from occurring within 12 hours of an educational event at the same location.
8. Prohibiting the collection of Scope of Appointment cards at educational events.
9. Placing discrete limits around the use of the Medicare name, logo, and Medicare card; this includes specifically prohibiting the misleading use of the Medicare name, CMS logo, and products or information issued by the Federal Government, as well as prohibiting the use of the Medicare card unless previously approved by CMS.
10. Clarifying the requirement to record calls between TPMOs and beneficiaries, such that it is clear that the requirement includes virtual connections such as video conferencing and other virtual telepresence methods.

Where does Pinnacle Financial Services come in?

While the Medicare Final Rule 2024 was implemented to protect beneficiaries and promote transparency, it is undeniable that these new regulations impose additional burdens on Medicare agents. The heightened requirements and restrictions may result in more extensive administrative work, increased oversight, and the need for constant vigilance to ensure compliance with ever-evolving CMS guidelines. Pinnacle Financial Services is a full-service “FMO” that is dedicated to helping agents navigate through the ever-changing rules and regulations imposed by CMS. Give us a call today for more information on key regulatory changes that could affect your business!