2 things agents can't do during Medicare Advantage OEP (and 3 they can)

There’s a Gordian knot of compliance rules to untangle in the Medicare market. And, the annual Medicare Advantage Open Enrollment Period (MA OEP) has its own strict set of rules health insurance agents must follow. Fear not, though. When you finish this 3-minute read, you’ll be ready to cut that knot – just like Alexander the Great.

But first – what is the MA OEP?

The MA OEP runs from January 1 through March 31 each year. Here are the highlights:

• Beneficiaries can only make one enrollment choice during MA OEP. It’s not like the fall where the last app in is the one that counts – they only have one shot to get it right.
  
  
• All enrollments have an effective date of the first day of the month following the enrollment request. Beneficiaries enrolling in a plan on February 2, for example, would have an effective date of March 1.
  
  
• Beneficiaries in Original Medicare cannot join an MA plan during MA OEP – they’d need to wait until AEP or a qualified SEP.
  
  
• MA OEP is not available to beneficiaries enrolled in a Medicare Medical Savings Account (MSA).

MA OEP compliance tips

CMS, understandably so, is very protective of beneficiaries during this time. And so, their Medicare Marketing and Communication Guidelines spell out very clearly what you can – and can’t – do during the first quarter.

You can’t target the OEP to make further sales

First things first: CMS prohibits agents from any activities that target MA OEP to make more sales. But what does that look like? Here are some things examples of things you can’t do or say:

• Unhappy with your new plan? Call me to learn about your options.
• Did you know you can switch Medicare Advantage plans through March 31? Schedule an appointment today.
• Buyer’s remorse? I can help you find a better Medicare Advantage plan.

All of these (and messages like them) clearly try to make more sales, so they’d break the rules—a big no-no.

You can bring up MA OEP if a Beneficiary does first

You can’t target the MA OEP to make more sales, but you can help clients (or prospects) who start a conversation.

They may not know of MA OEP, but should beneficiaries approach you about being unhappy with their plan, you can help. You can also educate them about their enrollment opportunities and timelines. Here’s what you could listen for:

• Am I locked into my current plan until October 15? Can I make changes before then?
• I’m not happy with my HMO plan because my doctor moved out of network. Am I allowed to switch?
• Are there any other plans available in my county?

If any conversation starts like this, you’ve got the green light to talk about MA OEP. You can also send marketing materials and have a one-on-one meeting.

You can’t use this time to reach out to folks you didn’t see during AEP

Having too many clients to see during AEP is a great problem to have – but it’s one you can’t solve during MA OEP. You’re prohibited from talking to your own clients about other plan options to try and generate sales. That’s also against CMS guidelines.

You can continue other marketing activities during MA OEP

Fearful of getting in hot water with CMS, some of you stop all marketing attempts during MA OEP. If you stay on the right side of the rules, you don’t have to. As long as your work doesn’t reference OEP or target the OEP to make more sales, here’s what you can do:

• Market based on other enrollment opportunities, such as age-ins
• Send marketing materials when a beneficiary requests them
• Have a one-on-one meeting at a beneficiary’s request

None of these target the OEP to make more sales, so they’re a-ok in CMS’s book.

You can use pre-approved marketing materials

When you’re making compliant outreach attempts – whether to age-ins, or those who contact you first – make sure your materials are approved by both CMS and the carriers you represent. Every Action agent gets an account manager, and each account manager is well-equipped to connect you to the resources to support your next move. And, we’ve got a stable of collateral for our agents to access in Ensurability.

Go forth and prosper

Your business doesn’t have to stop during MA OEP. Take the time to focus on compliant marketing efforts (hello, age-ins!), and you’ll be in a great spot to grow your business throughout the year. Not sure about your next steps? Talk to your account manager today. Don’t have one? Get appointed with us.