Medicare Advantage OEP

It’s the start of a new year and with it comes a new season of Medicare Advantage OEP. From now until March 31, individuals enrolled in an MA plan, including newly MA-eligible individuals, have an option to make a one-time election to switch to another MA plan (with or without Part D coverage) or return to Original Medicare (with or without Part D coverage).

AEP vs. OEP

The enrollment period that runs from October 15 to December 7 is the Annual Enrollment Period (AEP). Unfortunately, it is sometimes referred to as the Open Enrollment Period. Even CMS calls it that sometimes. This guide uses the correct definition of OEP as the enrollment period from January 1 to March 31.

The Run Down

Individuals enrolled in a MAPD or MA-only plan can use the OEP to get a different MAPD or MA-only plan, or they can return to Original Medicare (with or without a PDP). On the other hand, individuals enrolled in Original Medicare cannot use the OEP to join an MA or MAPD plan, add a PDP, or change their PDP. Also, the OEP is not available to those enrolled in Medicare Savings Accounts or other Medicare health plan types (such as cost plans or PACE).

Changing from MA to Medicare Supplement

You can change from an MA to a Medicare Supplement as long as your client can pass underwriting for the speciﬁc Medicare Supplement. OEP allows you to return to Original Medicare with or without a PDP, but it does not guarantee approval of a Medicare Supplement application. Agents need to remember that submitting an enrollment for a PDP will automatically disenroll their clients from their current MA plan and that the change cannot be easily undone.

We suggest submitting the enrollment application for a Medicare Supplement and waiting for approval before submitting a PDP enrollment, which again will automatically disenroll the client from their MA plan. If you do this, be sure your client will not be simultaneously enrolled in a Medicare Supplement and an MA plan.

CMS Marketing Guidelines

CMS guidance states that producers can’t knowingly target or send unsolicited marketing materials to any MA or MAPD enrollee during the continuous OEP. “Knowingly” takes into account the intended recipient as well as the content of the message.

During OEP You May

Market to dual-eligible and low-income subsidy (LIS)
beneﬁciaries who, in general, may make changes once per calendar quarter during the ﬁrst nine months of the year.

Market to age-ins (who have not yet made an enrollment decision).

At a beneﬁciary’s proactive request, send marketing materials, have one-on-one meetings, and provide information on the OEP.

Include general information on their website about enrollment periods, including the OEP.

During OEP You May Not

Speciﬁcally target beneﬁciaries who are eligible because they made a choice during AEP, by the purchase of mailing lists or other means of identiﬁcation.

Call or otherwise contact former enrollees who have selected a new plan during the AEP.

Engage in or promote agent/broker activities that intend to target the OEP as an opportunity to make further sales.

Send unsolicited materials advertising the ability/opportunity to make an additional enrollment change or referencing the OEP.

NCC Medicare Advantage Tools

NCC offers a wide range of online tools to help you navigate MA-OEP. Browse through the tools below for assistance with everything from quoting and enrollment resources; to carrier information and certification needs.