CMS has very specific guidelines on the type of marketing activity agents can initiate during Medicare Advantage Open Enrollment Period (OEP) that runs each year from January 1 through March 31.
OEP is only for Medicare beneficiaries currently enrolled in a Medicare Advantage (MA) plan or Medicare Advantage Prescription Drug (MAPD) plan. It does not apply to those with Original Medicare or a Medicare supplement plan. During this enrollment period individuals enrolled in a MA or MAPD plan can switch to a different MA or MAPD plan, or they can return to Original Medicare with or without a MAPD plan.
How to Stay Compliant During OEP: Do’s and Don’ts
Marketing initiated by an agent that is “knowingly” aimed at generating interest or leads during OEP is for the most part prohibited. Here’s what you need to know to stay compliant:
- Mention OEP and the ability to make an enrollment change in any educational or advertising materials.
- Solicit or target beneficiaries who just enrolled in a plan during AEP. This also means agents may not buy mailing lists of these individuals and market to them.
- Send any unsolicited marketing materials to encourage beneficiaries to change their enrollment.
- Host any marketing events that uses OEP as an opportunity to generate additional sales.
- Contact previous enrollees who used another agent to choose a new plan during AEP.
- Provide marketing materials in response to a client’s request.
- Set one on one meetings with clients who request a review of their plan choice.
- Target T65 prospects who have not yet selected a plan.
- Market to dual eligibles and LIS beneficiaries who may make changes once each calendar quarter in the first 9 months of the year.
- Focus on other SEP’s that allow plan changes such as the 5-star special enrollment period.
Having Compliant Conversations
When checking in with your clients during OEP it’s important to ask the right questions. There is a delicate balance between serving your clients and staying compliant. For clients who enrolled in a new plan during AEP, you can ask if they have any questions about their new benefits. You can ask your clients if there have been any changes to their health or personal circumstances. You should be careful not to ask leading questions. Let your client be the one to express dissatisfaction or the need for a change. They should initiate the request for information or a meeting with you.
Do you have questions about staying compliant during OEP? The dedicated team at PTT Financial is here to help. Contact us today.