CMS cracks down on 'misleading' Medicare Advantage marketing

Photo: Manuel Breva Colmeiro/Getty Images

The Centers for Medicare and Medicaid Services has responded to complaints that recent Medicare Advantage advertisements and marketing materials have been "confusing, misleading or inaccurate," at least in the minds of consumers.

Kathryn A. Coleman, director of the agency's Medicare Drug and Health Plan Contract Administration Group, recently sent a letter to all Medicare Advantage Organizations (MAOs) and prescription drug plan sponsors saying CMS will enhance its review of MA-related marketing materials. Such materials should be submitted under the "File and Use" regulatory authority for MA and Part D drug plans.

CMS has reviewed thousands of complaints and hundreds of audio calls, and said it identified numerous issues linked to television and newspaper ads, mailings, and internet searches. The agency called numbers associated with these ads in a "secret shopping" campaign meant to monitor these advertisements.

"Our secret shopping activities have discovered that some agents were not complying with current regulation and unduly pressuring beneficiaries, as well as failing to provide accurate or enough information to assist a beneficiary in making an informed enrollment decision," wrote Coleman.

She reminded MAOs and Part D sponsors that they're responsible for the marketing activities of the agents, brokers and other third-party entities with whom they contract. 

"CMS is closely monitoring marketing activities during the 2023 open enrollment, including marketing that is misleading, confusing, or misrepresents a benefit or product, and will take compliance action against plans for activities and materials that do not comply with CMS' requirements," wrote Coleman.

WHAT'S THE IMPACT

All marketing materials submitted under File and Use are "accepted" and may be distributed five days following their submission, said CMS. The agency can then review the materials for compliance; all other marketing materials that are not designated by CMS as qualifying for the File and Use framework must be prospectively reviewed, and approved or disapproved, during a 45-day review timeframe.

CMS said it's particularly concerned "with recent national television advertisements promoting MA plan benefits and cost savings, which may only be available in limited service areas or for limited groups of enrollees, overstate the available benefits, as well as use words and imagery that may confuse beneficiaries or cause them to believe the advertisement is coming directly from the government."

Beginning Jan. 1, 2023, no television ads will qualify for submission under the File and Use authority, said Coleman.

The agency will also be reviewing all marketing complaints received during the Annual Enrollment Period and will target their oversight and review efforts on the MAOs and Plan D sponsors with higher rates of complaints. It will continue its "secret shopping" efforts by reviewing television, print and internet marketing and calling related phone numbers, or requesting information via online tools.

THE LARGER TREND

CMS put forth a number of recommended best practices for MAOs and Part D sponsors, including ensuring beneficiaries know how to file a marketing complaint with 1-800-MEDICARE or the plan, as well as highlighting for beneficiaries that it's important to provide an agent or broker name, if possible.

It also suggested to sponsors that they ensure all agents and plan marketing materials clearly state when certain benefits may not be available to all enrollees.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com