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Medicare Final Rules - How to Make Them Work for You

In the last ten years, Medicare marketing costs doubled while member persistency decreased by more than 30%. This eroded member value and satisfaction. More troubling, beneficiary complaints filed with the Centers for Medicare and Medicaid Services (CMS) doubled in the same timeframe.

The number one complaint, according to the CMS Complaint Tracking Module (CTM) is beneficiaries felt they were enrolled in their plan “without their consent.”

Beneficiaries feel duped by misleading ads. They feel pressured into enrolling by aggressive agents. The 2024 CMS final rules are intended to address these issues. They will hold health plans, brokers and marketing partners accountable for lowering beneficiary confusion and dissatisfaction.

There are two new influential CMS final rules:

  • The prohibition of Medicare ads that do not mention a specific carrier by name—also known as the branded ads rule
  • A 48-hour minimum waiting period after scope of appointment (SOA)
Finding clarity

The branded ads rule is designed to ensure beneficiaries enroll in their intended plan by producing clearer and more accurate ads. The new rule requires each Medicare ad to display a single or group of carrier names. This way, beneficiaries know what companies they are considering.

Agents can only work with branded ads for which they have an appointment to prevent bait-and-switch schemes.

Some leading technology solution providers are building integrated leads-to-enrollment traceability for each branded ad. This helps brokers and agents ensure they comply with this rule. And, beneficiaries get more clarity and confidence on their enrollment.

No more speed dating

The 48-hour waiting period rule can potentially change the current beneficiary and agent experience for the better. Today’s speed dating approach is cold and rushed. Agents want to close on the first call because they know how hard it is to reach the prospect again.

Improving the experience

Since agents must now wait a minimum of 48 hours to complete a sale, why not reimagine the entire experience? A better experience means taking time to understand and document a prospect’s needs. It means educating them on their shopping journey and setting a convenient time to meet in person or over the phone.

Agents should ask, document and share the prospects’ needs, such as saving money, accessing more providers or getting more benefits. And do the same for their plans and benefits of interest, such as dental or flex card. This way, all parties are well prepared for a more pleasant shopping and enrollment experience.

During the 2023 AEP, MyMedicareBot tested this approach. We used a 24-48-hour waiting period as an alternative to the warm transfer or data leads process. We achieved significantly better conversion and member satisfaction results.

Moving from transactional to a relationship-based model can vastly improve industry economics. It also provides a better experience as the next 20 million people age into Medicare in the next 10 years.

Opportunity for change

The CMS final rule implementation provides the industry with a unique opportunity to fundamentally change Medicare marketing and distribution for the better.


This article was first published in Aspire Magazine.


Michael Cho
Co-Founder and CEO, MyMedicareBot