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Medicare Open Enrollment Period

 In Agent Updates, Compliance

To ensure we’re doing our part to keep everyone out of hot water and help provide valuable information to our agents, please see the below information regarding the new Medicare Open Enrollment Period (OEP).

The below information comes from the Medicare Communication and Marketing Guidelines updated September 5, 2018 and from the Medicare Advantage Enrollment and Disenrollment chapter of the Medicare Managed Care Manual.

Sections

The Rules

30.5 – Medicare Advantage Open Enrollment Period (MA OEP)

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During the MA OEP, MA plan enrollees may enroll in another MA plan or disenroll from their MA plan and return to Original Medicare. Individuals may make only one election during the MA OEP.

This chart outlines who can use the MA OEP and when:

Who can use the MA OEP: MA OEP occurs
Individuals enrolled in MA plans as of January 1 January 1 – March 31
New Medicare beneficiaries who are enrolled in an MA plan during their ICEP The month of entitlement to Part A and Part B – the last day of the 3rd month of entitlement

 

Individuals may add or drop Part D coverage during the MA OEP. Individuals enrolled in either MA-PD or MA-only plans can switch to:

  • MA-PD
  • MA-only
  • Original Medicare (with or without a stand-alone Part D plan)

 

The effective date for an MA OEP election is the first of the month following receipt of the enrollment request.

NOTE: The MA OEP does not provide an opportunity for an individual enrolled in Original Medicare to join a MA plan. It also does not allow for Part D changes for individuals enrolled in Original Medicare, including those enrolled in stand-alone Part D plans. The MA OEP is not available for those enrolled in Medicare Savings Accounts or other Medicare health plan types (such as cost plans or PACE).


40.7 – Prohibition of Open Enrollment Period Marketing

Plans/Part D 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, Plans/Part D sponsors may: 

  • 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 meetings with a sales agent; and
  • At the beneficiary’s request, provide information on the OEP through the call center

Note: The unintentional receipt of other marketing materials by beneficiaries who have already made an enrollment decision is not be considered knowingly targeting. For example, if a Plan sends mailers to a list of age-ins discussing the Initial Coverage Election Period (ICEP), it is possible that 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.

During the OEP, Plans/Part D sponsors may not:

  • 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.

What does this mean???

When is the OEP?

    • January 1-March 31 of every year
  • Age in’s who enroll in an MA plan during their ICEP have an OEP that runs from the month they are entitled to BOTH A and B through the last day of the 3rd month of their entitlement.

What can beneficiaries do?

If a beneficiary is enrolled in a Medicare Advantage plan, they’ll have a one-time opportunity to:

  • Switch to a different Medicare Advantage plan.
  • Drop their Medicare Advantage plan and return to Original Medicare, Part A and Part B.
  • Sign up for a stand-alone Medicare Part D Prescription Drug Plan (if they return to Original Medicare).

What can’t beneficiaries do?

  • Switch from Original Medicare to a Medicare Advantage Plan.
  • Join a Medicare Prescription Drug Plan, if they’re in Original Medicare.
  • Switch from one Medicare Prescription Drug Plan to another, if they’re in Original Medicare.

What am I allowed to do?

  • Conduct marketing activities that focus on other enrollment opportunities, including age-ins who haven’t yet made an enrollment decision, dual-eligibles, and LIS beneficiaries.
  • Respond by sending marketing materials to beneficiaries who make a proactive request for them.

What am I NOT allowed to do?

  • No soliciting. You can’t share materials advertising the ability to make a plan change or referencing the OEP in any way.
  • No targeting. Don’t purchase a mailing list or do anything else that might help you identify beneficiaries who are in the OEP because they made a choice during the Annual Enrollment Period. This includes your current clients.
  • Don’t try to change anyone’s mind. You may not contact former clients who have selected a new plan during the Annual Enrollment Period.
  • No OEP sales activities. You can’t engage in or promote any activities that intend to target the OEP as an opportunity to make further sales.

What do I do if I have questions?

Contact AgencyRM! We’re here to help you every step of the way.

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