What Do Proposed Changes to Medicare Marketing Guidelines Mean for the Future of Insurance Lead Generation? 

Connecting seniors searching for Medicare Advantage plans with authorized brokers may become more difficult starting in 2024 due to new Medicare marketing guidelines suggested by the Centers for Medicare and Medicaid Services (CMS). The CMS has proposed a ban on lead generation services, call monitoring, and “secret shoppers” to police an industry it sees as out of control.

Continue reading as we examine the new CMS marketing guidelines, how they could impact marketers going forward, and what led the CMS to make such a dramatic recommendation.

The Exploitation of Current Medicare Communication and Marketing Guidelines

Senior healthcare is critical for millions of Americans, as nearly 20% of the country’s population has reached retirement age. Medicare offers a federally backed healthcare solution designed to provide low-cost coverage for seniors, but Medicare plans often fail to cover care such as dental and vision. Medicare Advantage plans can cover these gaps by offering seniors privatized coverage more similar to commercial insurance plans than what Medicare typically provides.

Seniors face a constant bombardment of Medicare Advantage advertising. One survey found that 30% of seniors received seven or more phone calls a week during open enrollment from marketers, while another report found nearly 10,000 TV ads touting the benefits of Medicare Advantage ran daily. These advertisements typically tout the bonuses provided by Medicare Advantage plans, such as gym memberships, without disclosing that these plans require receiving care from in-network doctors and how difficult switching back to Medicare is once leaving for Advantage.

When seniors understand the ins and outs of switching to a Medicare Advantage plan, they can decide whether the additional services these plans offer are worth the required changes to how they receive healthcare. Unfortunately, dishonest marketers are taking advantage of senior confusion over the difference between Medicare and Medicare Advantage to switch people into plans that don’t always meet their needs.

A report issued by the Senate Finance Committee at the end of 2022 criticized what it saw as the widespread and predatory marketing of Medicare Advantage plans to seniors. The report highlighted that marketers were failing to tell seniors several key facts about Advantage plans, including:

  • Patients on Medicare can receive healthcare from any doctor or hospital that accepts Medicare, while Advantage plans require patients to see in-network providers to avoid paying additional fees.
  • Depending on where they live, using in-network services to avoid additional costs could require seniors to travel much farther than usual to receive care.
  • The cost of prescription drugs can vary between Medicare and Medicare Advantage, potentially increasing the price seniors must pay.
  • While switching to an Advantage plan is relatively easy, it can be challenging for seniors to switch back to Medicare once they have left a plan.

The new Medicare marketing guidelines proposed by the CMS seek to eliminate some of the loopholes and bad faith practices that allow dishonest marketers to target seniors so effectively.

What the New CMS Medicare Marketing Guidelines Mean for Brokers

Lead generation has steadily become one of the pillars on which Medicare Advantage brokers rely to find new business. Surveys have found that 68% of Advantage brokers say marketing is essential to their business. Roughly 39% said lead generation would be their primary marketing strategy in 2023, an increase from 32% in 2022.

As a result, traditional advertisements and cold calling have become far less popular. Over 52% of marketers reported cold calling less than in previous years, while 37% reported using fewer traditional advertising methods.

Despite lead generation’s vital role in connecting potential Medicare Advantage enrollees with brokers, the proposed CMS marketing guidelines could require businesses to make substantial changes to operating practices.

The proposed changes are far reaching and impact a variety of advertising, including:

  • An end to generic ads. Advertisements for Medicare Advantage must now include specific plan names to eliminate confusion over what someone may be enrolling in.
  • No more superlatives. Marketing materials can no longer use terms like “best” or “most” unless supported by accurate and recent data.
  • Expansion of Third-Party Marketing Organizations (TPMOs). CMS marketing guidelines have expanded the scope of what’s considered a TPMO to include any organization involved in marketing, sales, lead generation, or enrollment. This change seeks to hold all groups involved in marketing Advantage plans to the same accountability standards.
  • Stronger recording requirements. To ensure compliance and transparency, TPMOs must record all sales, marketing, and enrollment calls.
  • The use of verification agents. The CMS has also suggested using secret shoppers to verify that brokers are honestly answering questions from potential enrollees and not misrepresenting what Advantage plans provide.
  • Increased compliance standards. Lead generation services must meet stricter regulations, ensuring all advertisements are plan-specific and don’t use misleading statements.
  • Enhanced oversight. Lead generators will also be subjected to increased scrutiny by Medicare Advantage oversight organizations.

By implementing these changes, the CMS hopes to clarify the Medicare Advantage enrollment process, better protecting seniors and eliminating fraud.

eQuoto Can Help Keep You Compliant with Medicare Marketing Guidelines

At eQuoto, we understand the complexities and challenges that come with the new CMS marketing guidelines for Medicare Advantage plans. Our ethical lead generation strategies are designed to adapt to these new regulations, ensuring that your marketing practices remain compliant while effectively reaching your target audience.

We help you navigate these changes by prioritizing transparency, accuracy, and compliance. Don’t let new regulations hinder your ability to grow your business. Contact eQuoto today to discover how we can help you stay compliant and successful in the evolving landscape of Medicare Advantage marketing.


Couple review proposed changes to Medicare marketing guidelines
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