Benefits Buzz

New Medicare Reporting Requirements for Brokers

Posted on November 16th, 2022

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) published some new compliance rules that will impact Third-Party Marketing Organizations (TPMOs) who sell Medicare Advantage and/or Part D plans. The definition of a TPMO includes independent agents and brokers who are compensated for selling Medicare products.

Much of the focus of these new compliance rules surround the requirement for TPMOs to now record most phone calls with Medicare beneficiaries; however, TPMOs should also prepare themselves for new reporting requirements to insurance carriers.

Insurance carriers are starting to define processes to report any subcontracting relationships that TPMOs use for sales, marketing, lead generation, and enrollment functions. Additionally, insurance carriers are defining processes for TPMOs to report any disciplinary action taken against an agent or broker for non-compliance of the Medicare Advantage and Part D sales and marketing rules.

Some insurance carriers will require one or both reports to be done as frequently as every month. The method by which the reporting will need to be done will be defined uniquely by each insurance carrier.

CMS is taking a strong stance to protect Medicare beneficiaries from deceptive sales and marketing activities. CMS considers TPMOs to be an extension of the insurance carrier. They are placing strict new rules on insurance carriers which in turn is indirectly impacting TPMOs.

Insurance carriers are obligated to understand how their TPMOs are conducting sales, marketing, lead generation, and enrollment functions. Insurance carriers are also obligated to understand if any agent or broker of a TPMO has done anything which is prohibited under the Medicare Advantage and Part D marketing and sales rules.

All of this is in addition to the annual certification requirements that agents must complete to market and sell Medicare Advantage and Part D plans. Much of the certification places an emphasis on acceptable and unacceptable sales and marketing activities.


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