Medicare Advantage Open Enrollment Do's and Don'ts

It’s January and some of your clients in new Medicare Advantage plans give you call. They’ve changed their minds.

Changing health plans can feel uncertain as they transition from the known to the unknown. What happens when someone makes the move to try out a Medicare Advantage plan for the first time, or switches health plans, and then feels like their new coverage is not the right fit?

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Luckily for them, they’re not stuck with their new coverage. Almost immediately after the Annual Enrollment Period (AEP), beneficiaries in Medicare Advantage plans have an option to reconsider their plan selection.

Here’s what you need to know about the Medicare Advantage Open Enrollment Period (MA OEP) and the important do’s and don’ts that will keep you compliant.

Medicare Advantage OEP Qualifications

According to the Centers for Medicare & Medicaid Services (CMS), the Open Enrollment Period that most accurately applies to your clients hoping to switch plans after AEP is the MA OEP, if they qualify.

The MA OEP is specifically for:

  • Clients new to Medicare who enrolled in an MA plan during their Initial Coverage Election Period (ICEP). These beneficiaries have a three-month OEP that starts with the month they are entitled to Part A and B.
  • Those who enrolled in MA plans as of January 1. For these clients, there is an OEP from January 1 to March 31.

This means that your clients calling you in January who are unhappy with their new plan can make a one-time switch in coverage. What can they switch to? They have some options.

MA OEP Enrollment Cans & Can’ts

Here are the key enrollment guidelines to keep in mind:

Can... Can't...

Switch a client from one MA plan to another

Drop a client’s Medicare Medical Savings Account plan

Drop a client’s MA plan to return to Original Medicare

Disenroll clients with Original Medicare from any accompanying prescription drug plans

Enroll clients in a prescription drug plan, if they go back to Original Medicare

Try to change a client’s plan more than once

Try to enroll a client with Original Medicare in an MA plan

Remember the MA OEP was created for those with MA plans already, so new-to-MA enrollments are prohibited.

Part D changes are also limited and depend on changes to the MA plan. Clients can change their drug coverage by switching from one MAPD plan to another, by changing from an MA only to an MAPD plan, or by returning to Original Medicare and picking up a stand-alone Part D plan. Those with Original Medicare and a Part D plan cannot switch to another drug plan during MA OEP. They’ll have to wait for an SEP or the next AEP.

Marketing Do’s & Don’ts During MA OEP

A big difference for agents between the AEP and the MA OEP is the restriction on marketing.

Agents cannot knowingly target or send unsolicited marketing materials to MA or Part D enrollees during the MA OEP (January 1 to March 31). It’s important to note that “knowingly” takes into account the intended recipient as well as the content of the message.

Do's Don'ts

Host marketing events focusing on plans other than MA or Part D, such as:

  • Appealing to age-ins who have not enrolled in a plan yet
  • Marketing based on the continuous Special Enrollment Period (SEP) beneficiaries have to enroll in a 5-star plan
  • Reaching out to dual-eligible and Low-Income Subsidy (LIS) beneficiaries, since they can generally change plans once each quarter during the first nine months of the calendar year

Send beneficiaries unsolicited communications about the ability to make any additional changes or reference the MA OEP

Send marketing materials to a beneficiary who makes a proactive request

Target, by way of purchased mailing list or any other means, any beneficiary who’s in the MA OEP because they made a decision during AEP

Hold one-on-one meetings with beneficiaries who request them

Participate in or advertise any agent/broker activities that address the MA OEP as a means of making more sales

Give out MA OEP information if a beneficiary asks for it

Contact former enrollees who chose a new plan during AEP

Note: If a beneficiary who has already made an enrollment decision unintentionally receives marketing information, it’s not considered “knowingly targeted.”

Effective Date of Coverage and Beyond

Coverage on a plan chosen during the MA OEP begins the first day of the month following the month an MA company gets the enrollment request. But note that the company in question can decide whether or not they’re open to enrollments during MA OEP, which means your clients are not guaranteed a plan during this period.

That doesn’t mean they’re stuck if this is the case. Your client may be eligible for multiple enrollment periods occurring within this one. For instance, they may qualify for an SEP, so it’s possible their request for coverage will be accepted but under a different coverage start date.

Something to Think About

Before the MA OEP begins in January, reach out to your clients to make sure they understand their plans and that they are happy with them. Let them know you’re available if they have any questions or need further assistance. By doing so, you’ll provide your clients with a feeling of security, and as a result, they’ll be far more likely to refer their family and friends to you.

Remember, if you’re not contacting your clients throughout the year, another agent may seize the opportunity to gain their trust. A client who has questions or is confused with their plan is far more susceptible to let another agent write them into an MA plan next time around. Protect your business; don’t let the hard work you put into AEP go to waste.

Questions about compliance requirements during the MA OEP? Reach out to us at [email protected]

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