As the Medicare Annual Enrollment Period (AEP) comes to an end, agents need to remember the Medicare Advantage Open Enrollment Period (OEP). The Centers for Medicare and Medicaid Services (CMS) reinstated OEP starting 2019, allowing clients the opportunity to make a change. As an agent, you need to be aware of the guidelines affecting who can change and which changes they can make, as well as how your marketing abilities are affect during OEP.
What is OEP?
The OEP allows beneficiaries who are enrolled in a Medicare Advantage (MA) plan to make a change. This helps beneficiaries who were confused about how MA plans work and didn’t fully understand the plan, network, or copay costs associated with the plan they chose. The OEP runs from January 1st to March 31st.
However, newly eligible beneficiaries that enroll in a plan during their Initial Enrollment Period (IEP/ICEP) also have an OEP for 3 months following their MA start date (referred to as OEP NEW).
OEP NEW Example: If you enrolled in a Medicare Advantage Plan during your Initial Enrollment Period starting March, then your OEP NEW period is from March 1st to May 31st.
Who qualifies to use the OEP and what changes can they make?
The OEP applies only to those beneficiaries who are already enrolled in an MA plan as of Jan 1st. These beneficiaries can make one of the following a one-time changes during OEP:
- Switch from an MA-PD to a different MA-PD
- Switch from an MA-PD to an MA-only plan
- Switch from an MA-only to an MA-PD
- Switch from an MA-only plan to a different MA-only plan
- Drop MA-PD coverage and return to Original Medicare (You can join a PDP plan in this scenario)
- Drop MA-only coverage and return to Original Medicare (You can join a PDP plan in this scenario)
What can’t they do?
- Switch from Original Medicare to a Medicare Advantage Plan.
- Join a Medicare Prescription Drug Plan if you’re already in Original Medicare.
- Switch from one Medicare Prescription Drug Plan to another plan if you’re in Original Medicare.
How does OEP affect Agent marketing efforts?
Per CMS guidelines agents and plan sponsors are “prohibited from knowingly targeting or sending unsolicited marketing materials to any MA enrollee or Part D enrollee during the continuous Open Enrollment Period (OEP) (January 1 to March 31). “Knowingly” takes into account the intended recipient as well as the content of the message.”
During the OEP… you CANNOT:
- Send unsolicited materials advertising the ability/opportunity to make an additional enrollment change or referencing the OEP;
- Specifically target beneficiaries who are in the OEP because they made a choice during Annual Enrollment Period (AEP) by purchase of mailing lists or other means of identification;
- Engage in or promote agent/broker activities that intend to target the OEP as an opportunity to make further sales; or
- Call or otherwise contact former enrollees who have selected a new plan during the AEP
During the OEP… you CAN:
- Conduct marketing activities that focus on other enrollment opportunities, including but not limited to
- Marketing to age-ins (who have not yet made an enrollment decision),
- Marketing by 5-star plans regarding their continuous enrollment SEP, and
- Marketing to dual-eligible and LIS beneficiaries who, in general, may make changes once per calendar quarter during the first nine months of the year.
- Send marketing materials when a beneficiary makes a proactive request;
- At the beneficiary’s request, have one-on-one meeting.
You can view the Medicare Marketing Guidelines for further information at the CMS site: https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/FinalPartCMarketingGuidelines
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