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OEP – If Not for Everyone . . .  Then Who is it for?
The Medicare Advantage Open Enrollment Period – that runs from January 1, 2020 to March 31, 2020 – is only for beneficiaries currently enrolled in a Medicare Advantage Plan. The Centers for Medicare and Medicaid (CMS) allows beneficiaries one election during the first three months of the year to change plans.

What Changes Can Be Made?
There are certain changes that can be made during OEP. An individual can go from a Medicare Advantage plan with drug benefits to another Medicare Advantage plan with or without drug benefits. They can switch from a Medicare Advantage Plan without drug benefits to another Medicare Advantage plan with or without drug benefits.

But there’s more . . .  a beneficiary can also choose to go back to Original Medicare and elect a stand-alone prescription drug plan. Typically, this happens when the beneficiary is moving back to Original Medicare with a supplemental plan (Medigap) from a newly elected Medicare Advantage plan. If, and only if, it was the beneficiary’s first time enrolling in a Medicare Advantage plan, they can use their trial right to go back to the previous Medicare supplement plan that was in force for PY 2019 without evidence of insurability.

What Can You, the Producer, Do?
First, let’s visit what you cannot do during OEP.  The Open Enrollment Period is NOT designed to be a marketing period for producers. In fact, CMS strictly forbids producers from any advertising of this election period.

OEP is specifically allowed for by CMS to protect Medicare beneficiaries in Medicare Advantage plans in case they were confused, or subsequently discovered that their medications were not covered by the formulary, or that their doctors were not in the plan’s network.

What You Can’t Do

• Engage in activities that use the MA Open Enrollment Period as an opportunity for additional sales
• Call or contact enrollees who have made a new plan selection during the Annual Election Period – unless the you are contacting them to ensure that they have received their plan materials and that they understand them
• Purchase mailing lists or other identifiable information to directly target beneficiaries during the MA OEP because they selected an MA plan during AEP
• Send unsolicited marketing material referencing the MA OEP or the opportunity to make an additional enrollment change.

Producers Can

• Send marketing material if a beneficiary makes a proactive request for information
• Set up a one-on-one meeting (only at the beneficiary’s request)
• Market to people aging in to Medicare that have not made an enrollment or people with a Special Election Period

Things to Consider
If a beneficiary reaches out to you and you are working with someone who wants to switch from a Medicare Advantage plan to Original Medicare with a supplement and a drug plan, please do so carefully. While all beneficiaries can return to Original Medicare, not all beneficiaries are guaranteed a right to return to their prior Medicare supplement (Medigap) policies. Only those switching from Original Medicare to Medicare Advantage for the first time, are guaranteed the right to return to their previous Medicare supplement plan.

It is important to remember that unless the Medicare supplement can be reinstated without evidence of insurability, your client may lose coverage. Proceed cautiously. If you submit the PDP and the Medicare supplement application at the same time and the client is denied on the supplement plan, your client may end up with having original Medicare and a drug plan – with no supplemental coverage. So, understand the situation. It may be more beneficial for the beneficiary to select a different MA/MAPD plan.

Do what is right by the client.