Medicare Advantage Managers Propose 2024 Ban on Lead Sales

Lead-generation firms might mislead consumers by putting notices explaining the nature of the sites in fine print, or they might put too much pressure on consumers by requiring consumers to agree to let their contact information be resold before they can get access to Medicare plan information, officials say.

"In these situations, a beneficiary initiates contact with one organization and then ends up receiving calls from multiple other unrelated entities," officials report. "This practice goes beyond the scope of what we consider permissible."

CMS has proposed adding a rule stating that, "Personal beneficiary data collected by a TPMO may not be distributed to other TPMOs."

Agent Calls & 'Mystery Shoppers'

CMS officials say they listened to hundreds of Medicare plan sales call recordings and believe that agents provided the information needed only about 20% of the time.

Many sales calls are too short, focus solely on consumers' need for primary care and specific prescription drugs, and fail to cover the need for wheelchairs, oxygen systems and other durable medical equipment, officials say.

CMS is calling for insurers to address the problems by creating agent and broker compliance review programs that include monitoring of some agent calls and "mystery shopper" programs, or programs that have investigators call in and pretend to be consumers.

CMS also wants to require agents and brokers to review specified issues with consumers, including any drug or durable equipment needs, before recommending plans.

Agents would have to explain the effects of a customer's enrollment decision on current coverage whenever the customer makes an enrollment decision.

But the agency would narrow the scope of call recording requirements: Agents would have to record only calls that seem likely to lead to plan sales, not other types of calls, such as appointment-setting calls.

Other Plan Marketing Rule Proposals

The list of proposed marketing rule changes for 2024 also includes requirements that:

• Plans and TPMOs file marketing materials with CMS.
• Plans and TPMOs make provider directories searchable by any required information element, such as telephone number or address, not just by name and location.
• A plan issuer list the medical benefits offered in a specified order, so that agents and consumers find plan benefits easier to compare.
• A plan or TPMO avoid using superlatives, such as "best" in marketing materials, unless the plan or TPMO shows in the marketing materials that data in a credible, recently published document supports the use of the superlatives.
• A TPMO list state Senior Health Insurance Assistance Programs, in addition to the CMS Medicare.gov website and the 1-800-MEDICARE telephone hotline, as possible sources of information about Medicare plans.

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