2026 Updates
TPMO Compliance Corner
CMS is Watching: Chain of Enrollment
CMS is paying closer attention than ever to how beneficiaries move through the enrollment process – from the very first contact and lead generation all the way to submitting an application.
Good documentation is not just best practice – it is essential for staying compliant.
It is important that TPMOs are carefully tracking and documenting each step which means making sure you can clearly show how a beneficiary got from point A to point B.
Past Year Updates
Past Year Updates
2025
2025
Details
Details
Humana Final Rule PY2025 FAQ
Below is CMS’ FAQ’s pertaining to a significant change in a Medicare Advantage provider network, relevant special election periods and associated Medicare Supplement guaranteed issue rights for affected beneficiaries.
Key Changes for 2025 agents/brokers need to be aware of
Key Changes for 2025 agents/brokers need to be aware of
Approved Sales & Enrollments Scripts for PY 2025
Approved Sales & Enrollments Scripts for PY 2025
If you choose to create your own sales and enrollment scripts, please view the guidelines below prior to submitting for approval.
"One-to-One" Contact Rule
"One-to-One" Contact Rule
CMS Final Rule for 2025 states: “Beneficiary information collected by a third-party marketing organization (TPMO), including an agent/broker for purposes of marketing or enrolling the beneficiary into a Medicare health plan or Part D plan may only be shared with another TPMO when prior written consent is given by the beneficiary. The consent must list each entity receiving the data.”
What this means to you as an Agent:
You cannot share beneficiary contact information with another agent/TPMO unless the beneficiary has given written permission. This necessitates a change in verbiage on Lead Generation Forms (BRC/PTC). Spark will be using the following disclaimer on their BRC/PTC forms, you are welcome to use as well:
“By providing your name and contact information you are consenting to receive sales and marketing calls, text messages and/or emails from the licensed insurance agent listed on this form about Medicare Plans at the number provided, and you agree such calls and/or text messages may use an automated system for the selection or dialing of telephone numbers, automated voice calls, AI generative voice calls, pre recorded messages played when a connection is made, or pre recorded voicemail messages, even if you are on a government do-not-call registry. These calls are for marketing purposes and cellular charges may apply. This agreement is not a condition of enrollment and you can change your permission preferences at any time by contacting the agent listed on this form. “
Dual/LIS Special Election Period Change
Dual/LIS Special Election Period Change
Starting in 2025, full dual-eligible beneficiaries will have access to a new monthly SEP, which allows enrollment in highly or fully integrated Dual Special Needs Plans (HIDE/FIDE SNPs). In addition, any beneficiary qualified for LIS or Medicaid will be eligible for a monthly SEP to disenroll from their Medicare Advantage plan, return to Original Medicare, and enroll in a Prescription Drug Plan (PDP).
The quarterly SEP that many have used in the past for dual-eligible individuals and those receiving Part D low-income subsidies (LIS) is no longer available. The SEP available for the first 3 quarters of the year ended on September 30, 2024.
UHC has Individual State Guides
State Guides HERE or on Jarvis.
Here are instructions to get there: Jarvis > Knowledge Center > Medicare Product Resources > Dual Eligible Special Needs Plans > State-Level D-SNP Enrollment at a Glance Guides > State (click on the state of the client’s residence)
Devoted 2025 SNP FAQ
Wellcare 2025 Dual Eligible Plan Enrollment Guide
Humana HIDE/FIDE D-SNP Guide
Aetna has 2025 D-SNP Hot Sheets by State
Molina has a 2025 Plan guide which shows HIDE/FIDE/AIP
Elevance SNP 2025 Enrollment Guide
Change to Use of Disaster/Weather SEP
Change to Use of Disaster/Weather SEP
Beginning April 1, 2025 individuals wishing to use the Disaster/Emergency SEP must call 1-800-MEDICARE in order to make the election. Plans are required to remove the Disaster/Emergency SEP from enrollment forms and the Plans will only receive the enrollments from CMS. Here is the full CMS memo dated 12/3/2024.
2024
2024
In 2024, CMS is introducing significant changes to the CMS Marketing Guidelines. The changes are aimed at improving the quality of healthcare services and ensuring that patients receive the right information. They will become effective September 30, 2023.
The primary changes you should be aware of:
Call recording is limited to the point of enrollment: you no longer need to record appointment scheduling or retention activities
48-Hour SOA rule: you will need a signed Scope of Appointment (SOA) form 48 hours prior to the appointment. Exceptions include: the beneficiary is 4 days within the end of a valid election period, or the beneficiary is a walk-in
Updated disclaimer on Marketing assets: Please use this disclaimer We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options." Build your disclaimer HERE.
You may no longer use the Medicare Name, Logo or Card misleadingly: we recommend not using images of the Medicare card until CMS gives further guidance
Plans must notify enrollees annually, in writing, of the ability to opt out of phone calls regarding MA and Part D plan business.
Agents must explain the effect of an enrollee's enrollment choice on their current coverage whenever the enrollee makes an enrollment decision.
Limit the time that a sales agent can call a potential enrollee to no more than 12 months following the date that the enrollee first asked for information.
Prohibit a marketing event from occurring within 12 hours of an educational event at the same location.
Clarify that the prohibition on door-to-door contact without a prior appointment still applies after the collection of a business reply card (BRC) or scope of appointment (SOA).
Prohibit marketing of benefits in a service area where those benefits are not available, unless unavoidable because of the use of local or regional media that covers the service area(s)
Prohibit the marketing of information about savings available that are based on a comparison of typical expenses borne by uninsured individuals, unpaid costs of dually eligible beneficiaries, or other unrealized costs of a Medicare beneficiary.
Require TPMOs to list or mention all the MA organizations or Part D sponsors that they represent on marketing materials.
Require MA organizations and Part D sponsors to have an oversight plan that monitors agent/broker activities and reports agent/broker non-compliance to CMS.
Modify the TPMO disclaimer to add SHIPs as an option for beneficiaries to obtain additional help
Prohibit the collection of Scope of Appointment cards at educational events.
Prohibit the use of superlatives (for example, words like "best" or "most") in marketing unless the material provides documentation to support the statement and the documentation is based on data from the current or prior year.
Clarify the requirement to record calls between TPMOs and beneficiaries, such that it is clear that the requirement includes virtual connections such as video conferencing and other virtual telepresence methods.
2022/2023
2022/2023
Devoted Guide
Medicare Communications and Marketing Guidelines (MCMG)
Managed Care Manual (Chapter 21 & 9)