This guest blog post was written by Jagger Esch, President & CEO of Elite Insurance Partners and MedicareFAQ, a senior healthcare learning resource center. As a young entrepreneur and seasoned insurance expert, he has a passion for helping people. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate them on all their Medicare options. Jagger lives in the Florida sunshine state and loves boating with his family on the weekends.
There have been many occasions where a beneficiary enrolls in a subpar Medicare Advantage (MA) plan only to be stuck with their coverage for an entire year. The Medicare Advantage Open Enrollment Period will give agents the chance to help these beneficiaries.
What is the Medicare Advantage Open Enrollment Period?
Back in 2010, lawmakers decided to remove the Medicare Advantage OEP and replace it with the Medicare Advantage Disenrollment Period (MADP). The MADP gave beneficiaries the chance to disenroll from their MA plan and switch back to Original Medicare.
The MADP ran from January 1 through February 14 of every year, and dictated that beneficiaries couldn’t change MA plans. This meant they were still left vulnerable to healthcare expenses.
The return of the Medicare Advantage OEP means beneficiaries can switch from one MA plan to another MA plan from January 1 through March 31. During this enrollment period, beneficiaries are only able to make one switch. As an insurance agent, it’s your fiduciary responsibility to ensure your clients are enrolled in the best plan for them.
How Can You Ensure Your Clients Get the Best Coverage for Them?
When talking with your clients, it’s vital that you ask the right questions. Some important questions you can ask include:
- Do you have a Primary Care Doctor or Specialist that you need in your network of doctors?
- Do you take prescriptions that need to be covered under your insurance?
- Are you comfortable with a network of doctors, copayments, or co-insurances?
- If getting a referral is needed for a specialist, is that okay?
When you’re recommending a Medicare Advantage plan to a client, they need to understand that they may be subject to a network, a formulary, and they may be required to get a referral. If your client isn’t willing to settle for these things, then talk to them about a Medigap policy.
Understanding the Medicare Open Enrollment Period
While the return of the Medicare Advantage OEP means great opportunity for agents and beneficiaries, both should understand that you can’t change Part D Prescription Drug plans during this time.
If you have a client that has a stand-alone prescription drug plan, they will need to make plan changes during the Annual Enrollment Period (AEP) from October 15th through December 7th of each year.
The Medicare Open Enrollment Period allows for only one change—this is very important to understand. Once a change has been made during this time, no other changes may occur. When choosing a new plan, be sure to cover all the details required.
It’s an acceptable option for clients to disenroll from their MA plan and return to Original Medicare with or without Part D prescription drug coverage.
The Medicare Advantage OEP will allow “like plan” changes such as:
- MAPD to MAPD
- MAPD to Original Medicare and a Part D
- Original Medicare and a Part D to MAPD
- MA Only plan to MA Only plan
- MA Only plan to Original Medicare
- Original Medicare to MA Only plan
Any beneficiary that is returning to Original Medicare will be allowed to enroll into a Medicare Supplement plan. They will possibly need to go through medical underwriting, since this OEP doesn’t offer a guaranteed issue rate.
Beneficiaries can only enroll in a plan that has prescription drug coverage if their previous plan had Part D Prescription Drug coverage.
Why is the Open Enrollment Period Complicated for Medicare Beneficiaries?
New terminology should be set up to make things easier for Medicare beneficiaries and insurance agents. It doesn’t need to be complicated, but it should be simplified.
There are more Open Enrollment Periods than there needs to be and many people are confusing other enrollment periods with OEP. The return of the Medicare Advantage OEP is no exception to the confusion.
The Medicare Supplement Open Enrollment Period is for Medicare beneficiaries that are new to Medicare Part B. This period lasts 6 months and begins on the first day of the month that you turn 65 or older and enroll in Medicare Part B.
The Annual Enrollment Period (AEP) happens every year from October 15 through December 7. It’s commonly called the Open Enrollment Period. However, it’s not accurate to refer to AEP as OEP.
When a Medicare beneficiary turns 65 and receives Medicare Part B, they become eligible for the Initial Enrollment Period (IEP). This gives beneficiaries a 7-month time frame to enroll in a Medicare advantage plan. IEP, too, is commonly mistaken for Open Enrollment Period.
How will the Medicare Advantage OEP Affect Agents?
As a Medicare insurance expert, you know the feeling of a great AEP; the bonus checks, the constant steady work, and the feeling of helping people every day. With the new OEP, you can get pretty close to those feelings.
While only like plan changes are acceptable, you still have the chance to make a difference in someone's life for the better! You can also boost your commissions through the beginning of the year.
While there are plenty of beneficial things that come with the return of the Medicare Advantage OEP, it’s important that you’re aware of the Medicare Communications and Market Guidelines (MCMG) for 2019.
With the new changes, agents need to be mindful of “knowingly targeting.” The MCMG states that Plans and Part D Sponsors can't do the following:
- Send unsolicited materials advertising the opportunity to make an enrollment change or referencing the OEP
- Specifically target beneficiaries that are in the OEP because they made a choice during Annual Enrollment Period (AEP) by purchase of mailing lists or other means of acquiring information
- Promote agent or broker activities that intend to use the OEP as an opportunity to make further sales
- Call or contact former enrollees or clients who have selected a new plan during the AEP through another agent
As an agent, you should know and follow these guidelines. You can send marketing materials and hold one-on-one meetings, but only at the beneficiary’s request.
Remember, asking the right questions will help you determine if your clients qualify for a plan change. When you ask the proper questions, you can help make a real difference. If the beneficiary qualifies for a special election period and the OEP, you should select the special election period not the OEP.
When you sign up a beneficiary for a Medicare Advantage plan during the OEP, their coverage will begin on the first day of the following month. So, if your beneficiary enrolls in their plan January 20th, their coverage will begin February 1st.
Medicare Advantage plan recipients receive an Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) from their existing insurance carrier for their Medicare Advantage and Medicare Prescription drug plan providers by September 30th of each year.
CMS shares plan changes in October. If you can help a client change their plan during AEP that is best, since there is more flexibility during that enrollment period. As an agent, it’s your fiduciary responsibility to enroll beneficiaries in the most suitable plan for them the first time around.
Get FREE tools and insights from AgencyBloc delivered directly to your inbox.