How to Stay Productive in the Medicare Enrollment Off-Season

The 54-day AEP marathon has come and gone this year. So, catch your breath - but don’t put away that appointment book just yet.

There are several ways you can stay productive—and profitable—in the Medicare enrollment off-season. Due to extenuating circumstances, some of your Medicare Advantage (MA) enrollees may find themselves in need of a qualifying Medicare Supplement Plan or Special Needs Plan after regular open enrollment has ended. When those circumstances occur, your clients may be eligible to make changes during Special Enrollment Periods.

Special Enrollment Periods

Special Enrollment Periods (SEPs) allow qualifying members to make changes to their Medicare coverage after the close of AEP. They can enroll or disenroll in Medicare Advantage or Part D prescription drug coverage, based on specific circumstances, including:

- qualifying life events like changing where they live or losing their current coverage

- plan changes  because of a Medicare contract ending

- special situations like being eligible for both Medicare and Medicaid

Special-Needs Plans (SNP)

Medicare enrollees with limited incomes and resources who qualify for both Medicaid and Medicare are considered dual-eligible. If those dual-eligible enrollees have a change in their status, an SEP is available to them within three months of the change or notification of change, the later of the two. Essentially, they can change plans every quarter, providing you with more opportunities to sell.    

Additional SNP plans that may be available in your area  are Chronic-Condition Special Needs Plan (C-SNP) that serve beneficiaries with severe or disabling chronic conditions like cancer, HIV/AIDs, or chronic health failure.

Institutional Special Needs Plans (I-SNP) service beneficiaries living in a nursing home or other institution, or who need nursing care at home.

Prescription Part D SEPs

Both stand-alone Part D drug plans and Medicare Advantage plans have different designated special enrollments periods for certain circumstances.

●      Beneficiaries who qualify for low-cost Part D coverage or those who enter or leave a nursing home, can join a Part D drug plan or switch to another at any time of the year.

●      Beneficiaries who lose drug coverage from an employer, union, retiree benefits, COBRA, Medicaid, or Veteran Affairs programs can sign up for a drug plan within two months of their coverage ending.

●      Beneficiaries who move outside of their current drug plan’s service area can sign up with a new plan either before or within two months of the move.

●      Beneficiaries whose current Part D plan withdraws from their service area can switch to another plant before or when current coverage ends.

●      Beneficiaries who return to the U.S. after living abroad or are released from prison can sign up within two months of their return/release.

●      Beneficiaries can switch to a Part D plan or MA plan in their area that has earned the highest quality rating(five stars), anytime of the y ear except for the first week of December.  

Don’t think of AEP as an ending, but a beginning to your sales cycle. And make sure you follow up with your clients so they know you are available to talk about eligibility for SEPs should their life circumstances change throughout the year. When you partner with CareValue, you have the opportunity to add trusted carriers and their products to your product portfolio.

Get contracted with CareValue!

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