Applicability of the Guidelines
The CMS Medicare Communications and Marketing Guidelines apply to a variety of entities, including all Third-Party Marketing Organizations (TPMOs). These guidelines are specifically relevant to Medicare Advantage (MA) and Prescription Drug Plans (PDPs). They do not apply to products such as:
- Affordable Care Act (ACA) health plans
- Medicare Supplement (Medigap) insurance
- Other non-Medicare health insurance products
Definition of a TPMO
CMS defines a Third-Party Marketing Organization (TPMO) as any individual or organization—including independent agents and brokers—who is compensated to perform lead generation, marketing, sales, or enrollment-related activities connected to the MA enrollment process. This includes entities designated as First Tier, Downstream, or Related (FDRs).
Do CMS Rules Apply to Lead Vendors?
Yes. Lead vendors fall under the definition of a TPMO because they are paid to generate leads and perform marketing functions related to MA plan enrollment.
Understanding “Marketing Materials”
Under CMS regulations (§§422.2260 and 423.2260), “marketing” is defined as any communication or activity intended to influence a Medicare beneficiary’s decision to enroll in or remain enrolled in an MA or PDP plan.
Marketing materials are evaluated based on two criteria:
- Intent: Designed to attract attention to, or influence decision-making about, a specific MA or PDP plan.
- Content: Includes references to plan benefits, premiums, cost-sharing, incentives, or comparative plan information.
A material meets the Intent standard if it:
- Aims to promote a specific MA or PDP plan.
- Influences a consumer’s enrollment decision.
- Encourages retention in a current plan.
A material meets the Content standard if it:
- Mentions plan benefits, premiums, or cost-sharing.
- Includes metrics like Star Ratings, plan comparisons, or rewards.
Examples of Communication Materials
Example 1:
“ABC Health is now offering Medicare Advantage coverage in Nowhere County. Call 1-800-MA-AGENTS for more information.”
→ This qualifies as a communication piece. However, the use of a carrier name may require submission for carrier review.
Important: Any use of a carrier’s logo must be submitted for carrier review and approval.
Example 2:
A flu shot reminder letter stating, “ABC Health enrollees can get their flu shot for $0 copay at a network pharmacy…”
→ While cost sharing is mentioned, the piece is intended only to inform current enrollees, not to market a plan, and is therefore considered communication, not marketing.
Examples of Marketing Materials
Example 1:
“ABC Health Offers $0 Premium Plans in Nowhere County”
→ This includes both promotional intent and benefit-related content, qualifying it as marketing.
Example 2:
“Call us to learn about plans that include hearing, dental, $0 premiums, and Medicare Part B givebacks.”
→ Even without naming a specific plan, the mention of plan features and premiums qualifies this as marketing.
Note: Any material that mentions benefits or costs is considered marketing and must be submitted for carrier and CMS approval before use.
Requirements for Marketing Materials
When a piece is classified as marketing, you must:
- Submit the piece for pre-review to each carrier you represent.
- File the material in HPMS (Health Plan Management System) and obtain CMS approval.
- Ensure the material is used only for carriers that have explicitly opted in through HPMS.
Filing Requirements and Timeline
- Marketing materials must be filed in HPMS annually for each Plan Year.
- CMS typically opens HPMS for filing in June for the following plan year.
- Materials submitted between June–September may not be used before October 1.
- TPMOs must select the appropriate media type when submitting.
Carrier Pre-Review and HPMS Filing
TPMOs should coordinate closely with carriers and uplines to ensure compliance with the required pre-review and CMS filing processes. Carrier-specific processes may vary, and most carriers issue annual marketing guidance.
To independently file with CMS:
- Obtain consultant access to HPMS for your legal entity.
- Once access is granted, request that each carrier add your User ID to their HPMS workflow to allow visibility and opt-in capability.
For access instructions, refer to:
CMS Consultant Access Instructions (PDF)
Depending on your contract structure, you may also be able to request filing assistance from your upline or parent agency—but only for carriers within that agency’s hierarchy.
Shared Marketing Material and Unique SMIDs
If a TPMO uses a marketing piece originally created and approved by another TPMO, it must still be submitted in HPMS under its own unique SMID. Approval of the original piece does not extend to other TPMOs by default.
Can You Use an Unapproved Marketing Piece?
No. Marketing materials must not be used unless:
- They have been approved by CMS, and
- Each applicable carrier has opted-in via HPMS.
For further guidance or clarification, TPMOs should consult directly with their contracted carriers and compliance teams to ensure full adherence to CMS marketing standards.
