Understanding the CMS Ruling for the 48-hour SOA rule and New Marketing Requirements

If you're a Medicare broker, you're probably familiar with the Centers for Medicare & Medicaid Services (CMS) guidelines for Medicare Advantage and Part D plans. However, the recent changes in these guidelines, including the 48-hour SOA rule and updates to marketing requirements, have left some brokers wondering how to ensure compliance while still providing high-quality service to their clients.

The 48-Hour SOA Rule and “Digital” Walk-Ins

The 48-hour SOA rule mandates that brokers provide beneficiaries with a Scope of Appointment (SOA) at least 48 hours before a scheduled appointment to prevent misleading marketing tactics and protect beneficiaries. But how does this rule apply to “digital” walk-ins such as inbound calls, chatboxes, and SMS interactions? And can someone capture the SOA on a lead form? Currently, CMS has not provided any clarification on what is considered a "digital" walk-in, and we are awaiting further guidance.

According to CMS, the goal is to improve the customer experience, and this will likely limit the gray area where agents and call centers can operate. However, many concerns have been raised about the 48-hour rule in regard to inbound calls. Specifically, how many clients will answer a call back a few days later, and how this will impact business.

At Compass, we train all of our agents to do a two-step close, which involves a fact-finding and SOA call followed by a second appointment to review a prospect's top options. This approach allows the agent time to adequately research their client's best options and enables the client to take the time they need to make an educated decision, and ultimately choose the correct plan for their needs.

In our experience, if you adequately communicate your value as an advisor, you shouldn’t have a problem getting a new client to pick up the phone 48 hours later. This new law will likely hurt transactional agents who simply sign beneficiaries up for a plan without taking the time to fully research and understand the best plans for their client’s needs.

CMS is trying to create a better client experience, and if your processes are already in line with a quality client experience, you’ll likely be able to seamlessly navigate industry changes. That includes this new ruling and future rulings as well.

Marketing Requirements

In addition to the 48-hour rule, the new CMS ruling includes marketing requirements that brokers should be aware of. These requirements include:

• No marketing events at the same location within 12 hours of an educational event
• No marketing plan benefits in an area where benefits are not available
• Marketing information that revolves around savings is prohibited (specifically when in regards to the comparison of typical expenses for uninsured individuals, unpaid costs of dually eligible beneficiaries, or other unrealized costs of a Medicare beneficiary)
• Collection of SOA cards at educational events is prohibited
• Words like “most” or “best” when referring to Medicare assistance are prohibited in marketing materials

These requirements are designed to protect beneficiaries and ensure that brokers are providing accurate and compliant information about Medicare plans.

Compliance is Key

CMS is committed to improving the customer experience, and this latest ruling is just one example of their efforts. However, this does mean that brokers need to be aware of these changes to ensure they remain compliant while continuing to provide exceptional service to their clients. At Compass, we understand the importance of staying up-to-date on industry changes and have been actively training our agents on these new rulings for several weeks now.

While these changes can be daunting, they don't have to be overwhelming. With the right processes in place and a commitment to providing quality service, brokers can easily navigate industry changes and stay ahead of the curve. If you have any questions or concerns about this CMS ruling or any others, don't hesitate to reach out to your compliance department or a trusted industry expert.

As stated previously, we believe this change will likely harm transactional agents, but if you are running your business the way you should be - as a true advisor - you shouldn't have a problem navigating these changes.

Conclusion

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To download the ebook, simply click on the link in the description below. And if you have any questions or need further assistance, please don't hesitate to contact us for a free consultation. Our team of experts is here to help you succeed in the Medicare market. Thanks for watching, and we look forward to hearing from you soon!