Medicare plan agents and brokers should give up on telephone calls or online calls with any consumers who refuse to let the calls be recorded, according to guidance posted last week.
Officials at the Centers for Medicare and Medicaid Services, the agency that oversees the Medicare Advantage and Medicare Part D prescription drug plan programs, gave that advice in a batch of answers to frequently asked questions about the new CMS "third-party marketing organization" rules.
The new TPMO rules apply to all call centers, independent agents, captive agents and others involved with helping consumers sign up for Medicare Advantage or Medicare drug coverage.
One plan issuer told CMS, "We have received multiple questions from agents who want to know what they should do when a beneficiary is refusing to have the call recorded, but still want to enroll in our plan."
"There are no exceptions to this requirement," CMS officials say in the answer to that question. "If a beneficiary declines to be recorded, the call must end."
What It Means
The new call recording rules will have a direct effect on any clients who buy Medicare plan coverage over the phone.
Because so many people buy Medicare plans over the phone, the new call recording rules could have big, indirect effects on how regulators, lawmakers and businesses think about recording calls — like the existing bank transaction call recording rules.
The History
Two years ago, the Medicare plan market went through what looked like a gold rush.
National marketing organizations raced to put Medicare plan ads on television and to set up giant Medicare plan sales call centers.
Traditional agents and brokers suggested that many of the ads were misleading.
Some consumers asked Medicare for help with changing plans, arguing that call center reps had given them incorrect information about their original plans.
CMS officials say they reviewed call center sales call recordings created based on old recording rules, and found that 80% contained incomplete or incorrect information.
"Examples included beneficiaries being told that if their medication was not on the formulary, the doctor could tell the plan and the plan would simply add it; or incorrectly stating that 'nothing would change' when beneficiaries asked if their current health coverage would stay the same," officials say.
CMS responded to drafting and implementing TPMO rules.
TPMOs with limited plan menus must offer consumers the following disclaimer:
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 to get information on all of your options.
CMS already required Medicare Advantage plan sellers to record sales transactions completed over the phone.
CMS moved to require all TPMOs, including plan administrators and lead-generation firms, to record all calls from Medicare plan shoppers and enrollees.
The recording requirements took effect Oct. 1. The requirements apply to any coverage that will take effect on or after Jan. 1, 2023.
