An Agent's Quick Guide to Understanding the Medicare Advantage Open Enrollment Period

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In January 2019, CMS announced the comeback of the Medicare Advantage Open Enrollment Period. This period took over the old Medicare Advantage Disenrollment Period (currently discontinued). 

The Medicare Advantage Open Enrollment Period allows agents to help those who want to make a change to their current Advantage plan. 

It's too often we see recipients enroll in a mediocre plan only to be unhappy with the coverage for an entire year. Now, with the Medicare Advantage Open Enrollment Period, your clients have more time to make any necessary plan changes. 

Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period is back. So, what does this mean for your clients? For starters, it allows any Advantage plan enrollees extra options for a change. 

Your clients may use this time to switch to a different Advantage plan. Otherwise, beneficiaries may leave their current plan and go back to Original Medicare. Clients may do so with or without a Part D prescription drug plan (PDP). 

During Open Enrollment, clients may choose to make any of the following adjustments:

• Change from current Advantage plan to another
• Leave an Advantage plan with drug coverage for an Advantage plan without drug coverage
• Switch from any Medicare Advantage Drug Plan to another Advantage Drug Plan
• Leave an Advantage plan (with prescription coverage) and go back to Medicare (with or without Part D)
• Leave an Advantage plan (without drug coverage) and return to Medicare (with or without Part D)

The Medicare Advantage Open Enrollment Period is only for those who currently have a Medicare Advantage plan. Meaning, Original Medicare enrollees cannot use this time to join. Part A and B beneficiaries must enter Part C (Advantage plan) during the Annual Enrollment Period.

Both Medicare Cost Plans and Medicare Savings Accounts are exempt from the Medicare Advantage Open Enrollment Period. Furthermore, this enrollment period doesn't apply to individuals with Medicare Supplement insurance.

You may have some clients with a standalone drug plan. Be aware that these clients may not use the Open Enrollment Period to make changes to their drug coverage. 

Marketing the Medicare Advantage Open Enrollment Period 

The new year brings a new opportunity to enroll as the Annual Enrollment Period is over. As an agent, you want to prepare and be ahead of the game. During the Medicare Advantage Open Enrollment Period (January 1st - March 31st), agents have some marketing rules to follow. One of the most important is that CMS prohibits any marketing or targeting during this time. 

What Agents CAN Do During Medicare Advantage Open Enrollment Period

No need to worry, you can still help clients find the best plan type during this enrollment period. Agents can send marketing materials, but only at the beneficiary’s request. 

You may also conduct sales meetings, but again, only when a beneficiary requests it. Be sure not to "lead" towards such a request. 

It's always necessary to remain knowledgeable and educate your clients. Agents should be ready to address any concern(s) about the enrollment period when asked. 

Lastly, market to people who are either dual-eligible or are aging into the Medicare program. We call these individuals "Age-ins." 

What Agents CANNOT Do During Medicare Advantage Open Enrollment Period

CMS determines the Medicare Communications and Marketing Guidelines (MCMG). Agents should stay up-to-date on current enrollment period guidelines. Moreover, review the most recent memo about the updates. 

You can find both documents on the CMS website. To help ensure quality service, we've laid out some marketing rules for agents to follow. 

• During the Medicare Advantage Open Enrollment Period, agents can NOT engage in or promote any agent activities as a chance to make more money. 
• Agents must not target clients who've made changes during the Annual Enrollment Period. Meaning, you may not buy mailing lists of such individuals and market to them. 
• You may not target Part D or Advantage Plan enrollees during the Open Enrollment Period. Agents should also refrain from sending undesirable marketing materials to advertise the enrollment opportunity. 
• Do not contact former beneficiaries who used another agent to join a plan during the Annual Election Period.

These guidelines are essential for you to follow. But, don’t stress too much about the rules. Accidents happen; for instance, you may (accidentally) send marketing materials to clients who joined during Annual Enrollment. 

The Medicare Communications and Marketing Guidelines offer an example of this. "If a Plan sends mailers to a list of age-ins discussing the Initial Coverage Election Period (ICEP), some recipients may have already made an enrollment decision. However, the content of the message to the intended audience of age-ins is not prohibited OEP marketing."

How Will the Medicare Advantage Open Enrollment Period Affect Agents?

Medicare insurance experts know the feeling of a successful Annual Enrollment Period. You know that feeling of seeing the bonus checks roll in, the steady pace of constant work, and how good it feels to help people every day. 

Well, agents, there's good news! During the Medicare Advantage Open Enrollment Period, you can relive all those feelings—or at least some of them. 

Plan changes are only acceptable if they are alike. For example, they're leaving one Advantage plan for another Advantage plan. Or they’re changing from one with drug coverage to another that also has drug coverage.

Yet, this doesn't mean you can't help change someone's life for the better. When you ask your clients the right questions, you can make a significant difference. 

Ask Your Clients the Right Questions

Asking the right questions may look like the following. Some of your clients may qualify for a Special Election Period AND the Advantage Open Enrollment. If this happens, use the Special Election Period and not the Open Enrollment Period. 

Upon enrolling a person in a plan during the Advantage Open Enrollment Period, their coverage starts on the first day of the next month. So, let's say you enrolled Tommy in an Advantage program on January 26th, his coverage starts February 1st. 

Advantage plan members receive an Annual Notice of Change. Beneficiaries also receive an Evidence of Coverage from their current insurance company. 

Both notices include upcoming changes to Advantage plans and Prescription Drug Plans. Clients can expect these in the mail each year by September 30th. 

Be sure to look out for plan changes made by CMS every October. It's always best to try to help a client make plan changes during the Annual Enrollment Period. This election period is ideal because there's more flexibility during that time.

As an agent, do your due diligence to enroll clients in the most comprehensive plan for their needs, and it’s always best to do so the first available chance.

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Posted by Jagger Esch on Tuesday, March 17, 2020 in Senior Market Insurance

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