OEP (Open Enrollment Period) is one of the roughly 30 election periods recognized by CMS (Medicare) for individuals to enroll into a Medicare Advantage or stand alone prescription drug plan. It was implemented in 2019 and lasts annually from January 1 through March 31.
Who is OEP For?
Open Enrollment Period is NOT for everyone. The period is only for individuals who go into January of the new year on a Medicare Advantage plan. CMS grants consumers one election during the first three months of the year to change plans.
If and when someone changes plans, they are essentially stuck with that choice for the remainder of the year unless they have another special election period. If the beneficiary does not make a change, they will have to keep the plan they have until the next Annual Election Period (some exceptions apply).
What Changes Can Be Made During OEP?
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.
The individual can also choose to go back to original Medicare and elect a stand-alone prescription drug plan. Most of the time when this happens, they are moving to a supplemental plan (Medigap) from a Medicare Advantage plan.
"If 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."
If 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. Remember that if you submit the PDP and the supplement at the same time and the client gets denied on the supplement plan, you then put your client in the unfortunate situation of only having original Medicare and a drug plan.
In most cases, this puts the client at much greater risk and becomes problematic for them and your reputation. It is advisable to write the supplement and make sure it is approved and then go back to write the drug plan. While this adds an extra trip and extra work, it's the right thing to do.
Important OEP Policies
OEP is not designed to be a marketing period for agents. CMS strictly forbids agents or carriers from any advertising of this election period.
OEP was designed to protect Medicare beneficiaries in Medicare Advantage plans in the event that they were confused or misled by an agent, did not discover that a medication was not covered on their current plan, or that a doctor was not in the plan’s network. (Keep in mind that formularies and provider networks can change annually on Medicare Advantage plans.)
How Does This Benefit You, the Agent?
So how can you benefit from OEP as an agent? If someone approaches you and expresses dissatisfaction with their MA plan during the first quarter, you are allowed to discuss OEP options with them and help them find a plan more appropriate to their needs.
It is vital to remember that you can and should be marketing all year long for age-ins, dual eligibles, and those who receive extra help with their drug cost. This can be done during the first quarter and, if written, the agent should use the appropriate SEP code (not OEP).
If you have any questions about OEP or anything else, we are always here to help. Give us a call at 888-622-9122 to speak with an expert agent support specialist. You can also check out this blog post and video on the variety of special election periods, or this recorded TMG agent conference call regarding special election periods to learn more. We wish you the best in your business and personal lives.