Newsletter

Volume 5, Number 44

2024 MEDICARE MARKETING GUIDELINES ISSUED

CMS (Medicare) issued final regulations on April 12 concerning marketing of 2024 Medicare Advantage and Prescription Drug plans.

CMS requires that a Scope of Appointment Form (SOA) be signed before an agent can discuss any Medicare Advantage or Part D drug plan. In recent years the Scope of Appointment form could be signed immediately before a sales or marketing appointment with a beneficiary. Beginning October 1, the SOA must be signed by a beneficiary at least 48 hours prior to such an appointment unless the beneficiary is a walk-in to the agent’s office (or attending a sales event) OR if the beneficiary is within the last 4 days of a valid election period (e.g., between December 4 and 7 for the Annual Enrollment period).

This change will mean there must be a two-step sales process in talking with most beneficiaries: first, the SOA must be signed and second, the sales or marketing appointment must be scheduled at least 48 hours after the SOA is signed. 

We are awaiting clarification about how this change will affect discussions with existing clients, but our present plans are to initiate annual review phone calls with beneficiaries in September. We will give clients the opportunity to update their medication and provider lists with us as part of this call. We’ll provide further details as we obtain more clarification about the new requirements.

The disclaimer that must be read to Medicare Advantage and Part D clients and prospects within the first 45 seconds of a phone call will need to identify the number of organizations and clients offered by the agent.

The recording requirement that was initiated October 1, 2023 will only be applicable to sales/marketing and enrollment calls, but it’s been clarified that this requirement will apply to Zoom and screen sharing calls that deal with enrollments or marketing.



CMS has tightened the sales and marketing guidelines in an effort to prevent confusion primarily caused by unscrupulous agents and call centers. We’ll provide more details as we receive guidelines from carriers and any additional information from CMS.

MORE VACCINES ARE FREE FOR PEOPLE WITH PART D

As a result of the Inflation Reduction Act, even more vaccines are now free for people with Part D drug plans (either stand-alone or Medicare Advantage Prescription Drug Plans).

Examples of vaccines now covered under Medicare Part D include:

• Shingles
• Tetanus/diphtheria (Td)
• Tetanus, diphtheria, and pertussis (whooping cough) (Tdap)
• Hepatitis A
• Hepatitis B

Flu shots, COVID-19 vaccines, and pneumococcal shots are still covered by Medicare.

Part D plans won’t charge you a copayment or apply a deductible for vaccines recommended by the Advisory Committee on Immunization Practices (ACIP):

Vaccine-Specific ACIP Recommendations

• Anthrax
• Cholera
• COVID-19 
• Dengue
• DTaP-IPV-Hib-HepB
• DTaP/Tdap/Td
• Ebola
• Hepatitis A
• Hepatitis B
• Hib
• HPV
• Influenza
• Japanese Encephalitis
• Measles, Mumps and Rubella
• MMRV
• Meningococcal
• Orthopoxviruses (Smallpox and Monkeypox)
• Pneumococcal
• Polio
• Rabies
• Rotavirus
• Typhoid
• Varicella (Chickenpox)
• Yellow Fever
• Zoster (Shingles)

TWO PART D CHANGES FOR 2024

Here are two changes to Medicare drug programs for 2024, as outlined by the Pan Foundation:

Expansion Of The Federal Low-Income Subsidy (LIS) Or Extra Help Program

Beginning in 2024, there will no longer be a partial program in the Low-Income Subsidy (Extra Help) program. Full benefits will be offered to people with Medicare with limited resources and incomes up to 150 percent of the Federal Poverty Level. With full benefits, the majority, if not all out-of-pocket costs for prescription medications will be covered.

Visit our Extra Help education hub to learn more about this program and see if you qualify.

Elimination Of The Five Percent Coinsurance For Part D Catastrophic Coverage



Beginning in 2024, the five percent prescription cost-sharing obligation for Part D will be removed. Currently, when someone on Medicare has spent around $3,100, they will enter what’s called the catastrophic phase of their benefit. In this phase, they will have to pay five percent of prescription costs for the rest of the year, without a maximum limit. According to a 2022 Kaiser Family Foundation brief, the changes will be like having a cap of about $3,250 for the calendar year.

About Paul Cholak

Paul is a licensed, independent health and life insurance agent and has over forty years of benefits experience and specializes in helping Medicare beneficiaries obtain health insurance. However, he offers a complete array of life and health insurance products to individuals of all ages.

He guides Medicare beneficiaries through the steps of getting insurance and is available to help clients both BEFORE and AFTER they've made their purchase decision.

Disclaimer for Part C and D plans: "We do not offer every plan available in your area.  Any information we provide is limited to those plans we do offer in your area.  Please contact Medicare.gov or 1-800-MEDICARE (TTY: 1-877-2048) to get information on all your options."

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