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Ways Agents Can Guide Clients Through Medicare Advantage Open Enrollment Season

Medicare Advantage OEP season runs from January 1st through March 31st and gives you a great opportunity to connect with your policyholders. This is the time of year when individuals enrolled in a Medicare Advantage (MA) plan are allowed to make a one-time election to go to either another MA plan with or without Rx coverage or to Original Medicare with a stand-alone Prescription Drug Plan (PDP). While this enrollment period provides beneficiaries with a choice of plans if something isn’t working with their new or existing plan, CMS compliance guidelines restrict agents from marketing OEP to prospective customers.

It’s important to stress to your policyholders that these are important dates during which they can switch coverages or plans. So, communication goes a long way toward meeting client needs.

Here are some ways you can help policyholders navigate the Open Enrollment Period:

Understand Client Options 

It’s always beneficial to understand what clients are able to do during OEP. It lets policyholders know they may have some important choices regarding plan benefits, deductibles, and copays. Some clients may even qualify for a subsidy that helps pay for plan premiums and prescription copays. And, as an agent, it helps keep you at the forefront of a client’s mind. Continuous communication helps build client loyalty and engagement while offering them educational opportunities.

Review Existing Plans 

The OEP allows you to review existing Medicare Advantage policies and help clients make informed decisions about switching coverages or understanding available networks of doctors and hospitals. You may help a client by focusing on gaps in coverage, which may determine how much money a policyholder pays out-of-pocket. These may have changed over the past year regarding medical conditions and/or budget. Perhaps a policyholder now has a need for prescription drug coverage, and now is the time when Part D coverage can be added.

Communicate Allowable Changes 

The first quarter of the new year allows clients to make specific changes to their coverage. There are limits to what a policyholder can do during this time. You can help clarify how customers can tailor their MA plans to suit their needs. Here are things they can do within the OEP:

  • Switch from an Original Medicare plan to Medicare Advantage
  • Switch from Medicare Advantage back to an Original Medicare plan.
  • Switch from one Medicare Advantage Plan to another.
  • Switch to a Medicare Advantage Plan without drug coverage from a Medicare Advantage Plan that includes drug coverage.
  • Switch from a Medicare Advantage Plan offering prescription drug coverage to a Medicare Advantage Plan without drug coverage.
  • Enroll in a Medicare drug plan.
  • Move from one Medicare drug plan to another Medicare drug plan.
  • Opt out of Medicare drug coverage entirely.

Understand Agent Limitations 

Understand that you can assist clients, but there are some activities you can’t pursue during OEP. Here’s a brief rundown:

  • You can’t contact customers to increase enrollments during the Medicare Advantage Open Enrollment Period.
  • You can’t knowingly solicit Medicare Part D or Medicare Advantage Plan enrollees with marketing and sales material perceived to shift focus from the intended purpose of the OEP.

Enlist the Help of a Partner 

Serving clients’ needs and staying compliant with Medicare regulations should go hand-in-hand. A policyholder can rely on your guidance and look toward self-help resources available from private and public entities. While the landscape can sometimes be cluttered, Claro’s Agent Resource Center can help provide agents with the knowledge they need to market and sell Medicare insurance effectively. Contact us today to see how we can help you along the way during Medicare Advantage Open Enrollment.

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