Understanding the New CMS Rules and How They’ll Impact Your Business

The Centers for Medicare and Medicaid Services (CMS) just released an update to its rules that have significant implications for insurance agents and Medicare agencies that market Medicare plans. These changes aim to enhance transparency, protect participants, and ensure that any information provided is accurate.

Let’s explore these new CMS rule changes, the implications they’ll have on marketing collateral and participant communications, and the importance of remaining compliant in the Medicare marketing landscape.

Direct Submission of Marketing Material by TPMOs

One of the most significant changes introduced by the new CMS rules is the requirement for Third-Party Marketing Organizations (TPMOs) to submit their marketing materials directly to CMS for approval. Under the previous guidelines, TPMOs were responsible for submitting material to the respective Medicare Advantage (MA) organizations or Part D sponsors. However, the new rule mandates that TPMOs obtain prior approval from each organization or sponsor and submit the material directly to CMS for review. This ensures that marketing collateral meets CMS guidelines and receives the necessary approvals before participants see it.

This means TPMOs need to align their internal processes to accommodate the direct submission to CMS and ensure compliance with the approval requirements of individual organizations and sponsors. Total Expert can help TPMOs streamline marketing collateral development and approval workflows while remaining compliant at every step with our automated workflows and pre-built content templates.

Prohibition on Misleading Use of Medicare or CMS Name and Logo

To protect participants from misleading information, the new CMS rule strictly prohibits the use of the Medicare name, CMS logo, and products or information issued by the Federal Government in a misleading way. However, a slight modification to the rule now permits the use of the Medicare card image with authorization from CMS. This change aims to strike a balance between accurate representation and preventing deceptive practices.

For insurance agents and Medicare agencies involved in marketing Medicare plans, this rule demands that you adhere to the guidelines and obtain proper authorization from CMS when incorporating Medicare-related branding elements like the Medicare card image in marketing collateral. Ensuring accurate and transparent representation builds trust with participants and avoids potential compliance issues that could lead to significant fines for each violation.

Clear Identification of MA Organizations and Part D Sponsors

Under the new CMS rule, marketing material must clearly identify the MA organization or Part D sponsor offering the products or plans. This requirement aims to provide participants with clear and accurate information about the entities behind the marketing material. By clearly identifying the MA organization or Part D sponsors involved, participants can make informed decisions about their Medicare plan choices.

For insurance agents and Medicare agencies, transparency is not optional. Participants must have clear and easy access to further information about the plans and services being advertised.

Restrictions on Unsubstantiated Superlatives

The new CMS rule introduces limitations on the use of superlatives such as “lowest premium” or “largest network” in marketing collateral. To ensure compliance, such superlatives must be supported by documentation and/or data that validates such claims. The supporting documentation and data should reflect the current or prior year and should be easily accessible to participants.

For insurance agents and Medicare agencies, this is another rule change that demands transparency and honesty. Many common marketing communication approaches will no longer be allowed. Any claims about service quality, price, etc. Must be backed by reliable data and documentation. Incorporating such supporting information not only complies with CMS guidelines but also earns trust with participants who seek reliable information to make informed decisions about their Medicare plans.

New Disclaimers for TPMOs

The new CMS rule introduces standardized disclaimers that TPMOs must include in their marketing material. These disclaimers will inform participants about the TPMO’s representation of MA organizations or Part D sponsors and the range of plans available. The disclaimers differ based on whether TPMOs represent all MA organizations or Part D sponsors in a service area or only a select number.

For TPMOs representing a select number of organizations, the disclaimer states that they do not offer every plan available in the area and that participants should contact Medicare.gov, 1-800-MEDICARE, or their local State Health Insurance Program (SHIP) for information on all available options.

For TPMOs representing all MA organizations or Part D sponsors in a service area, the disclaimer states that they represent a certain number of organizations offering a specific number of plans. Participants are advised to contact Medicare.gov, 1-800-MEDICARE, or their local State Health Insurance Program for assistance with plan choices.

These disclaimers continue to ensure transparency and help participants understand the scope of plans represented by TPMOs. Insurance agents and Medicare agencies must incorporate the required disclaimers accurately in their marketing collateral to meet CMS compliance standards and provide participants with clear information about available plan options.

Penalties for Violating CMS Rules

CMS exists to protect Medicare and Medicaid participants, a group that has often been targeted by misleading and predatory marketing practices. As a result, CMS will not hesitate to impose up to a $5,000 fine for each violation of their policies.


Compliance with the new CMS rules is essential for ensuring transparency and protecting participants, but also for avoiding potentially devastating financial penalties. Total Expert can help insurance agents and Medicare agencies navigate these changes and deliver communications remain CMS-compliant by streamlining the creation, approval, and distribution of any marketing collateral.

Our pre-built, CMS-compliant templates and content library ensure that the required disclaimers are included on all collateral, while the automated workflows provide a centralized system for collaboration and approvals that maintain an audit trail of compliance activities.

Outdated technology and internal processes will make it difficult to comply with the new CMS rules. By embracing a modern technology platform like Total Expert, you can empower your sales teams with the marketing collateral and peace of mind they need to communicate with participants and comply with evolving regulatory requirements.