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1 (800) 772-6881 x7731 | sales@pfsinsurance.com
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support@pfsinsurance.com
Welcome to the latest edition of Wellcare Insider, your source for important updates and reminders to help you provide excellent service and grow your business all year long
Today’s edition has information on the following topics:
Navigating the do’s and don’ts for activities during the Medicare Advantage Open Enrollment Period (OEP) can make all the difference between surviving or thriving year-round. Understanding the rules and leveraging your knowledge throughout the period can help set you up for your most successful year yet.
Start by reviewing some of the do’s and don’ts for marketing and sales activities:
Learn more about allowed and disallowed MA OEP marketing activities by reviewing the Medicare Advantage Open Enrollment Period Marketing Guidelines.
1 (800) 772-6881 x7731 | sales@pfsinsurance.com
1 (800) 772-6881
support@pfsinsurance.com
It’s important to know what to do and what not to do during OEP. To help you stay compliant, we have put together some helpful tips below.
To view the full Code of Federal Regulations, click here.
Market to Medicare Advantage age-ins who have not yet made an enrollment decision.
Market to D-SNP-eligible and LIS beneficiaries who, in general, may make changes once per calendar quarter during the first 9 months of the year.
Send marketing materials when a customer requests information.
Conduct one-on-one meetings at the customer’s request.
Provide information about OEP through the call center if a customer asks.
During OEP, you cannot:
Send unsolicited materials advertising or referencing OEP directly to your customers.
Purchase mailing lists or other identifying information to specifically target customers during OEP.
Engage in or promote activities intended to target OEP as an opportunity to make further sales.
Call or otherwise contact customers who selected a new plan during AEP.
Disaster (DST) Special Election Period (SEP) Compliance
To ensure you stay compliant, we want to remind you of the Centers for Medicare & Medicaid Services (CMS) guidelines regarding the use of a DST SEPs throughout the year.
SEP for Government Entity-Declared Disaster or Other Emergency
42 CFR 422.62(b)(18)
(Rev. 2, Issued: August 12, 2020; Effective/Implementation: 01-01-2021)
An SEP exists for individuals affected by a disaster or other emergency declared by a Federal, state or local government entity who were unable to, and did not make an election during another valid election period. This includes both enrollment and disenrollment elections.
Individuals are eligible for this SEP if they:
The SEP starts on the date the declaration was made or the incident start date whichever is earlier. The SEP ends two full calendar months following the end date identified in the declaration or the date the end of the incident is announced, whichever is later.
Please note when using DST SEPs:
1 (800) 772-6881 x7731 | sales@pfsinsurance.com
1 (800) 772-6881
support@pfsinsurance.com
Medicare’s Open Enrollment Period (OEP) provides Medicare Advantage beneficiaries a one-time opportunity to make a change to their 2024 plan. During this time, you will have opportunities as well; to support prospects that are seeking help to make a change, and to strengthen your role as a trusted Medicare advisor.
Know the rules
You can help beneficiaries, who reach out to you, find a plan that is better for them. Read our OEP Fact Sheet to ensure you know what you can and can’t do to grow your business during OEP.
Retention opportunity
Be proactive! Take time to check in with your clients to ensure they understand their benefits and have what they need to begin using them. Doing so will help strengthen your rapport and may impact plan retention.
1 (800) 772-6881 x7731 | sales@pfsinsurance.com
1 (800) 772-6881
support@pfsinsurance.com
Medicare’s Open Enrollment Period (OEP) is a time for individuals to review and adjust their Medicare coverage. Understanding the intricacies of Medicare OEP is essential for making informed decisions about healthcare plans. Below, we discuss the rules and opportunities with the Medicare OEP, which has replaced the previous Medicare Disenrollment Period.
The Medicare Open Enrollment Period, occurring annually from January 1st to March 31st, is pivotal for beneficiaries. It’s designed to offer flexibility and a chance to reassess one’s current Medicare coverage. This period is particularly significant as it replaces the former Medicare Disenrollment Period, which was limited to January 1st to February 14th each year.
One of the most notable changes in the OEP is its extended duration. Now, running for three months provides ample time for clients to consider their options without feeling rushed. During this period, beneficiaries have a one-time opportunity to change their existing plans. This flexibility is crucial for adapting to new healthcare needs or financial considerations that may have arisen since the initial enrollment.
The OEP allows for changes to a “like plan.” Understanding what this means is crucial for making the right decision. The term “like plan” refers to a specific set of allowable changes. These include:
While the OEP provides an opportunity to make changes, switching should be based on individual healthcare needs. It is advisable to consult with a healthcare advisor or use Medicare’s resources to understand the implications of each option. Personalized advice can help beneficiaries navigate the complexities of Medicare and make choices that align with their healthcare needs.
| During the OEP, you may not: | During the OEP, you may: |
|---|---|
| Send unsolicited materials advertising the ability/opportunity to make an additional enrollment change or referencing the OEP | Market to age-ins (who have not yet made an enrollment decision) |
| Specifically, target beneficiaries who are in the OEP because they chose AEP by purchasing mailing lists or other means of identification | Market to dual-eligible and low-income subsidy (LIS) beneficiaries who, in general, may make changes once per calendar quarter during the first nine months of the year |
| Engage in or promote agent/broker activities that intend to target the OEP as an opportunity to make further sales | At a beneficiary’s proactive request, send marketing materials have one-on-one meetings, and provide information on the OEP |
| Call or otherwise contact former enrollees who have selected a new plan during the AEP | Include general information on your website about enrollment periods, including OEP. |
Medicare’s Open Enrollment Period allows beneficiaries to reassess and adjust their healthcare plans. By understanding the rules and options available, such as the ability to switch to a “like plan,” beneficiaries can make decisions that better suit their evolving healthcare needs. It’s a time for careful consideration and consultation with Medicare experts to ensure the choices are in the best interest of one’s health and well-being. However, navigating the complexities of Medicare can be challenging.
For personalized guidance and more detailed information on how OEP works, it’s advisable to contact a knowledgeable Medicare team member. Pinnacle Financial Services provides expert assistance and can be a valuable resource in this process. You can contact us at 800-772-6881 x-7731 or email support@pfsinsurance.com for support. For more comprehensive insights and updates, visit our OEP page. The team can help you understand the nuances of Medicare plans and ensure that your choices are in the best interest of your client’s health.
1 (800) 772-6881 x7731 | sales@pfsinsurance.com
Vice President, Marketing
1 (800) 772-6881
support@pfsinsurance.com
The National Association of Benefits and Insurance Professionals (NABIP) represents more than 100,000 licensed health insurance agents, brokers, consultants and benefit professionals through nearly 200 chapters across America. NABIP members service the health insurance needs of large and small employers as well as people seeking individual health insurance coverage.
- Networking Opportunities: Connect with industry leaders, experts, and like-minded professionals through our events, conferences, and online forums.
- Professional Development: Access cutting-edge resources, workshops, and training programs designed to enhance skills and stay ahead in today’s competitive business landscape.
- Exclusive Discounts: Enjoy special discounts on industry-related events, publications, and services, saving both time and money.
- Visibility and Recognition: Showcase your expertise and achievements on a national platform, gaining recognition among peers and potential collaborators.
- Collaborative Projects: Explore opportunities for collaboration and partnerships within our diverse and dynamic community.
With our website (www.nabip.org), America’s Benefit Specialist (ABS) magazine and several newsletters and broadcast emails at your fingertips, you’ll always have the most current industry information.
NABIP strives to educate officials on both the federal and state levels about the healthcare system and the vital role of the health insurance agent as a consumer resource and advocate. Through a network of key contacts, NABIP cultivates relationships that allow members to clarify issues before bills are written and votes are taken. These relationships are strengthened through actions undertaken by the NABIP Political Action Committee (NABIP PAC).
All NABIP members receive a complimentary subscription to America’s Benefit Specialist magazine. ABS is filled with valuable articles and information, including sales tips and best-practice ideas.
Certification programs, professional designation courses, online resources and conferences are just a few ways NABIP helps members develop professionally and personally. Local chapters also host regular meetings where continuing education opportunities are provided.
From an exclusive agreement with Mercer for agent-preferred E&O insurance to discounts on compliance tools and tech solutions, NABIP offers you the opportunity to save money on items you need to operate your business.
Interacting with other insurance professionals may be the most beneficial aspect of NABIP membership. Being able to reach out to other professionals, asking questions, meeting sales representatives and learning about products are all invaluable opportunities that membership provides. NABIP also offers online networking resources that connect members across the country.
1 (800) 772-6881 x7731 | sales@pfsinsurance.com
1 (800) 772-6881
support@pfsinsurance.com