How to Provide Nonhealth-Related Information to Medicare Enrollees


During the Medicare enrollment process, beneficiaries may have other, nonhealth-related questions that apply to their stage in life—but not directly to Medicare. The beneficiary may ask questions such as, “Do I qualify for adult daycare?” or “Do you know of any good assisted living facilities?”

Before you answer, here’s what brokers need to know about providing Medicare enrollees with nonhealth-related information.

What Kind of Nonhealth-Related Information Can a Broker Provide?

Often, brokers are asked questions about topics ranging from house-cleaning services to assisted living facilities.

Brokers may respond with suggestions—such as names of people and facilities—of where the beneficiary can go to receive more information regarding their question. Referring beneficiaries to their local state health insurance assistance program (SHIP) office is advised, as it is a neutral, state-run entity.

However, brokers may not give endorsements or recommendations. Brokers may say something such as this: “I cannot give a personal recommendation, but I can give you suggestions of who to contact for more information. Be advised that Medicare has neither reviewed nor endorsed this information.”

When Can Brokers Provide Nonhealth-Related Content?

Nonplan- and nonhealth-related content can be provided to enrollees once prior authorization is received, according to the Centers for Medicare and Medicaid Services rules (MMG, Section 120.1).

Can Brokers Deliver Nonhealth Materials With Plan Materials?

No. The materials cannot be delivered with plan-related materials, including in mailings, on websites, or during outbound telephone calls related to current plan information.

Does Nonhealth-Related Information Need to Include a Disclaimer?

Yes. All material needs the following disclaimer: Medicare has neither reviewed nor endorses this information.

How Can Enrollees Provide Authorization?

According to CMS rules (MMG, Section 160.3) enrollees can complete authorization in the following scenarios.

  • In person at marketing events, health fairs, or other public venues.
  • Over the telephone, provided the authorization is recorded. The call must be an enrollee-initiated inbound telephone call, and scripts for such calls must comply with CMS guidelines (MMG, Section 40.3) .
  • Via an email to the plan, provided that the authorization includes an electronic signature.

Can Brokers Include a Request for Authorization on the Enrollment Form?

No.

Where Can I Get More Medicare Marketing guidance?

Our resource center is available 24/7 to give you the help you need with Medicare guidelines, sales advice, and more to keep your business on track. To learn more about the Excelsior team and how we can help you, contact us.

 

Source: https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/CY2019_Medicare_Communications_and_Marketing_Guidelines.pdf
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References
https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/CY2019_Medicare_Communications_and_Marketing_Guidelines.pdf

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