Understanding Medicare OEP Rules
The Medicare Open Enrollment Period (OEP) occurs each year between January 1st and March 31st. It is important to understand the Medicare OEP rules. A client must be on a Medicare Advantage plan to take advantage of the OEP opportunity. If your client is currently on a Medicare Advantage plan, they can either make a one-time switch to a different Medicare Advantage Plan or go back to their Original Medicare and enroll in a stand-alone Prescription Drug Plan. The new plan would be effective the first of the month following the submission of the enrollment.
It is important to remember that, while the client may drop their MA plan and go back to Original Medicare and a PDP, they will NOT automatically be Guarantee Issue Acceptance for a Medicare Supplement plan. They would need to follow that state/carrier rules regarding plan acceptance. Using the OEP enrollment selection does not disqualify a client from using their quarterly Special Election period for a Dual Special Needs Plan if they have both Medicare and Medicaid.
Medicare OEP “Do’s and Dont’s”?
CMS has specific marketing guidelines that must be followed during OEP. Agents may not knowingly target or send unsolicited marketing materials to any MA or Part D for the purpose of using their OEP option to change plans. “Knowingly” takes into account the intended recipient as well as the content of the message.
Do 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 the Annual Enrollment Period (AEP) by the 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.
Do
- Marketing to age-ins (who have not yet made an enrollment decision);
- Marketing by 5-star plans regarding their continuous enrollment SEP;
- 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
Medicare OEP Training
We hold webinars multiple times throughout the week covering a variety of topics, including Medicare OEP and other marketing opportunities. Be sure to always check the Enrollment Period Guide if you have questions on eligibility. Reach out to our support team for training calendars from each carrier in your area.
For more information on Medicare OEP and one-on-one support, click here to contact your Sales Director.
1 (800) 772-6881 x7731 | sales@pfsinsurance.com
Vice president | health sales
Contact a Pinnacle Representative if you have any questions.
1 (800) 772-6881
support@pfsinsurance.com
