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The Medicare Open Enrollment Period (OEP), which runs from January 1st to March 31st each year, is an important time for Medicare beneficiaries. It allows individuals enrolled in Medicare Advantage plans to make certain changes to their coverage. Here are key rules and guidelines for the Medicare OEP: Medicare Advantage Plan Changes: Prescription Drug Plan Changes: No Changes for Standalone Part D Plans: No Effect on Medigap Policies: One-Time Change: Coverage Effective Dates: No New Enrollments for Medicare: Marketing Restrictions:
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Understanding these rules is crucial for anyone working with Medicare beneficiaries, especially insurance agents and healthcare advisors, to ensure compliance and provide accurate guidance.
Compliance with rules for selling Medicare Advantage (MA) and Part D prescription drug plans (PDP) is the responsibility of everyone serving Medicare customers.
This guide was developed to aid compliance throughout all stages of the sales process and includes critical information and useful tips to keep in mind at all times.
Making a Compliant MA/PDP Presentation
Featuring a handy check list, presentation phases are covered in three sections:
Prior – Key points
- Understanding what is permissible and not permissible to discuss with a prospective client
- Knowing what questions to ask
- Being prepared to sell
During – Necessary steps
- Making proper introductions
- Providing necessary disclosures
- Being up-to-date on relevant published materials such as provider networks, drug formularies and plan benefits, premiums and client costs
- Ensuring clients understand all aspects of the sales process
After – Important follow-up actions
- Seeing if the customer has any questions about the plan they’ve chosen
- Confirming client understanding of benefits, coverages, co-pays/co-insurance and provider network information
- Making sure the customer has the agent’s contact information
Things to Know
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👉 Do • Clearly identify the products to be discussed, and ONLY discuss those agreed |
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👉 Do Not • Discriminate in any way, including discouraging enrollment for the disabled• Attempt to enroll someone with a diminished capacity to understand • Engage in high-pressure sales or scare tactics or use misleading, conflicting, confusing statements • Collect financial information during pre-enrollment activities • Imply Medicare is only available to seniors • Offer monetary or promotional gifts to induce enrollment or to compensate based on use of services |
Other Points of Interest
In addition to the preceding information, the compliance guide addresses the following topics:
- Compliance metrics
- Avoiding client complaints
- Primary care physician auto-assignments
- Marketing during Pre-AEP and prior to October 1
- Do’s and don’ts for conducting an educational event
- And more!
Download the Compliance Guide here!
