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2024 Final Rule: Important reminders and updates

Compliance Reminders:

  • Marketing materials developed by a Third-Party Marketing Organization (TPMO) for multiple plans must be submitted into HPMS by the TPMO. Submission may only occur after the TPMO receives prior approval of each of the Medicare Advantage Organization or Prescription Drug Plan on whose behalf the materials were designed and developed by the TPMO.
  • The Scope of Appointment (SOA) must be signed at least 48 hours prior to a personal marketing appointment or meeting, with the exception of a) when a beneficiary requests an appointment within 4 days of the end of a valid election period, and b) when a beneficiary initiates an in-person meeting by visiting an agent’s office/kiosk.
  • SOAs and business reply cards (BRCs) are valid to 12 months from the beneficiary’s signature date or the beneficiary’s request for more information.
  • CMS modified the TPMO disclaimer to add State Health Insurance Programs (SHIPs) as a source of information for beneficiaries. CMS also added an additional disclaimer requirement which would require all TPMOs to identify only the number of organizations and total number of products available to the beneficiary where they reside.
  • TPMO calls for marketing, sales and enrollment must be recorded in their entirety. This also applies to the audio portion of web-based calls.
  • Contacting a beneficiary at the individual’s home is unsolicited door-to-door contact unless an appointment at the beneficiary’s home at the applicable date/time was previously scheduled.

Compliance Updates:

CMS finalized two new special enrollment periods (SEPs) during which Medicare-eligible individuals may make changes to their Medicare Advantage or Part D coverage outside of the annual election enrollment period. The new SEPs are available to beneficiaries who enroll in Original Medicare using an exceptional SEP (i.e., a special enrollment period for people who missed a Medicare enrollment period due to exceptional conditions). The MA or Part D plan enrollment is effective the first of the month following the month the MA or Part D plan receives the enrollment request.

  • Part C SEP for individuals to enroll in an MA plan or MAPD plan when they use a Medicare exceptional condition SEP to enroll in Premium Part A and/or Part B.
  • Part D SEP for individuals to enroll in a stand-alone PDP when they use a Medicare exceptional condition SEP to enroll in Premium Part A or Part B.

Additionally, the Final Rule modifies the timeframe and enrollment effective date for the preexisting Part D SEP for individuals who enroll in Part B during the General Enrollment Period (GEP).

  • The SEP will begin when the individual submits their application for Part B and continue for the first two months of enrollment in Part B with Part D enrollment effective the first of the month following the month the PDP sponsor receives the enrollment request.

The Final Rule also expands eligibility for the full LIS and low-income cost sharing (LICS) to individuals with incomes up to 150% the federal poverty level.

  • Individuals will qualify for the full subsidy based on the higher income and resource requirements currently applicable to the partial LIS group, providing the full LIS subsidy for those who currently qualify for the partial subsidy. Individuals who qualify in 2023 for the partial LIS subsidy and continue to qualify in 2024 will not have to take any action to transition to the full subsidy.