Wellcare | Weekly News – 01/01/2023

January 2, 2023

With the new year underway, we wanted to provide information on the following member enrollment opportunities we are sure you will find helpful as you continue to work with your members:

  • MA Open Enrollment Period (MA OEP) – Enrollment timeframe and guidelines for MA OEP
  • SEP Reminders – SEP guideline reminders and Wellcare active SEP resource

Medicare Advantage Open Enrollment Period (MA OEP)

The Medicare Open Enrollment Period (MA OEP) is already in full swing. Please note the following information regarding MA OEP:

  • MA OEP occurs from January 1, 2023 – March 31, 2023.
  • MA OEP marketing guidelines differ from AEP guidelines, as this is not considered to be a “second selling season”.
  • During OEP, current Medicare Advantage (MA) members can make a one-time change to their MA or MAPD plan or return to Original Medicare.
  • When a member elects to make a change, the effective date of the change will be the 1st day of the following month. Example: If a member makes a change anytime in the month of February, the effective date of the plan change will be March 1, 2023.
  • Members currently enrolled in a PDP contract (e.g. S4802) are not eligible to use MA OEP.

You are encouraged to review the Medicare Advantage Open Enrollment Marketing Guidelines for additional information on this topic.

Special Enrollment Period (SEP) Reminders

As a reminder, Wellcare regularly alerts our broker partners of any new or updated FEMA or state declared SEPs to ensure you are equipped and ready to assist beneficiaries and members that may qualify for additional enrollment opportunities. These alerts are sent to brokers who are contracted and licensed in the impacted area(s).

SEPs are election periods outside of IEP, AEP and MA OEP where a qualifying individual may enroll into or disenroll from a plan or change their current plan election. Please note the following SEP guidelines stated below:

  • There are various types of SEPs, each with specific eligibility criteria, time frames and effective dates. Please ensure that these are fully met before placing a SEP enrollment request.
  • An individual might be eligible for a SEP but would also have to meet the eligibility criteria of the plan selected for enrollment.
  • IMPORTANT: For SEPs related to disaster declarations, the individual must actually be impacted by the disaster AND would have otherwise qualified for an election period during the impacted timeframe.
  • Unless stated otherwise, an individual meeting the SEP and plan eligibility criteria can only make a one-time change to their plan election.
  • The SEP for the individual ends when the individual elects a new plan or when the SEP time frame ends, whichever comes first, unless specified otherwise within a SEP.

You are encouraged to view the SEP section in the CMS Enrollment and Disenrollment Guidance for Medicare Advantage (MA) (Section 30.4) and/or Prescription Drug Plan (PDP) (Section 30.3) for detailed descriptions of the various types of SEPs and their eligibility criteria.

Our SEP FEMA / State Declarations Resource provides a comprehensive list of all active SEP communications sent as well as recently expired SEPs. Be sure to add this link as a bookmark in your internet browser to ensure you never miss a SEP that may be active in your area.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881


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