CMS Issues a Memo Clarifying the Definition of Marketing

The Centers for Medicare & Medicaid Services issued a memo on May 10, 2023 to clarify the definition of marketing for Medicare Advantage-Prescription Drug Plans, stand-alone Prescription Drug Plans, 1876 Cost Plans, and Third-Party Marketing Organizations.

The memo explains that the MCMG defines marketing as communication materials and activities which meet specific intent and content standards.

The intent component of the definition of “marketing” is met when any material or activity is intended to:

1. ‍Draw a beneficiary's attention to plan or plans‍
2. Influence a beneficiary's decision-making process when selecting a plan
3. Influence a beneficiary's decision to stay enrolled in a plan (that is, retention-based marketing).

The content component of the definition of “marketing” is met when any material or activity includes or addresses:

• Plan benefits
• Benefits structure
• Premiums
• Cost sharing
• Measuring or ranking standards
• Rewards and incentives

Until now, we've been allowed to mention widely available benefits, such as vision, dental, premium reduction, and hearing, and that hasn't been considered "marketing."

CMS took the stance that these general descriptions aren't enough to actually draw attention to a particular plan. They truly believed that a beneficiary would not make an enrollment decision based on a general description of dental benefits, as an example – particularly when there is no information there about the associated cost for enrollees.

However, CMS has recently discovered through their surveillance, reviews, and discussions with interested parties that people do in fact enroll based on the mention of these very general and broad benefits.

The memo says:

"Beneficiaries have contacted agents, made calls to 1-800 numbers, and responded to flyers asking about the dental, vision, hearing, and cost-savings being marketed."

As a result, CMS has expanded their interpretation of the regulatory definition of “marketing” to include content that mentions any type of benefit.

Beginning July 10, 2023, any material or activity that is distributed via any means (e.g., mailing, television, social media, etc.) that mentions any benefit will be considered marketing and must be submitted into HPMS. 

New Horizons is committed to ensuring you have marketing materials that are CMS-approved. Please take advantage of our approved materials, which you can easily access when you register and login to our website.