WHAT'S WAPPENING?

TACKLE your Medicare Advantage OEP Game Plan

Posted by Jean A. Lentsch on 2/10/21 12:39 PM

Medicare-Advantage-OEP

The Medicare Advantage Open Enrollment Period runs from January 1- March 31. It is important to remember the rules of this Special Election period – Agents/Plans cannot market OEP and Member Eligibility.

Who is eligible?

ONLY Members who have a Medicare Advantage plan effective January 1, 2021 are eligible.

Members enrolled in Original Medicare and / or stand-alone PDP plans are not eligible for the Open Enrollment.

What changes are allowed?

Only one plan change is allowed during this period, and the new plan will be effective the first of the following month.

  • Switch from MA/MAPD to another MA/MAPD plan
  • Switch back to Original Medicare – with or without part D
  • Note: Access to Medigap may require medical underwriting

What are the compliance regulations surrounding OEP marketing?

During the MA, OEP agents may only conduct marketing activities for the following:

  • T65 age-ins
  • 5-Star plans
  • Dual -eligible / LIS

Educational materials must not reference OEP.

During the MA, OEP agents may NOT:

  • Create marketing materials referencing the MA OEP
  • Target beneficiaries who are in the OEP by purchasing mailing lists
  • Engage or promote activities that intend to target the OEP to make further sales
  • Call former enrollees who have selected a new plan during AEP

How to code your OEP app:

SEP CODE

MA OEP = January 1 – March 31 (one election effective the first of following month)

OEP

Member has an MA/MAPD plan effective 1/1 - May change to another MA/MAPD plan

OEP NEW

Individual must be enrolled in an MA Only, MA-PD and within the first 3 months of their Part A and Part B start date.

OEP I – Institutionalized

Moves into, resides in, or moves out of a Skilled Nursing Facility (SNF), nursing facility (NF), intermediate care facility for the mentally disabled, psychiatric hospital, rehabilitation hospital, Long Term Care (LTC) hospital, or swing-bed hospital with an expecting stay of at least 90 days.

What is your GAME PLAN for OEP?

While CMS strictly prohibits OEP Marketing, you have several options for retention and prospecting during this time and the rest of the year. Here are some ideas:

Your GOAL is to continually check in with your clients and foster the relationship. Regarding OEP, make sure that you communicate with your clients to ensure they are educated and comfortable with their AEP plan change. If not, it is your duty to educate them on their options. 

WAP is here to support your efforts every step of the way. If you have any questions, contact us!

Topics: Medicare Advantage OEP

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