At the beginning of 2019, CMS is restoring the Open Enrollment Period (OEP). This is not the same OEP you may remember prior to 2011, so it’s important to be aware of the rules relating to this enrollment period.
What you need to know
When is the OEP?
- January 1 through March 31 each year for all Medicare beneficiaries
- For newly Medicare eligible individuals, the OEP occurs the first 3 months in which they have both Part A and Part B (OEPNEW)
When do OEP elections take effect?
- The plan will go into effect the first of the month following the receipt of the enrollment request
Who can use the OEP?
- Individuals who are currently enrolled in an MAPD or MA-only plan as of January 1st
What changes can be made during the OEP?
- Individuals enrolled in an MAPD plan can use the OEP to enroll in a different MAPD, MA-only plan or Original Medicare (with or without a PDP)
- Individuals enrolled in an MA-only plan can use the OEP to switch to a different MA-only plan, an MAPD or Original Medicare (with or without a PDP)
- Note: if a client would like to sign up for a Medicare Supplement plan, they would be subject to underwriting unless they are eligible for a guarantee issue situation
What changes are not allowed during the OEP?
- Individuals enrolled in Original Medicare cannot us the OEP to join an MA or MAPD, add a PDP or change their PDP
- In addition, the OEP is not available for those enrolled in a Medicare Savings Plan
How many plan elections can be made during OEP?
- Only one election
OEP Do’s and Don’ts
During the OEP, you may not:
- Send unsolicited materials advertising the ability/opportunity to make an additional enrollment changes or referencing the OEP
- Engage in or promote agent/broker activities with the intent to target the OEP as an opportunity to make further sales
- Call or otherwise contact former enrollees who have selected a new plan during the AEP
- Market to individuals who are aging- in
- Market to dual-eligible and low-income subsidy beneficiaries
- At the beneficiary’s request, send marketing materials, have one-on-one meetings and provide information on the OEP
OEP examples for newly eligible individuals
Example 1: A beneficiary’s 65th birthday is on June 20, 2019, and she is eligible for both Part A and Part B on June 1
- Her Initial Election Period (IEP) is 3 months before, the month of, and 3 months following the month of entitlement: March 1 – September 30, 2019
- She enrolls in an Aetna MAPD plan effective June 1
- MA OEPNEW for her begins the month of entitlement to both A and B (June) and continues through the last day of the 3rd month of entitlement (August). In other words, her MA OEPNEW runs from June 1 – August 31.
Example 2: A beneficiary’s 65th birthday is April 20, 2018, and she is eligible for both Part A and Part B beginning April 1, 2018. She continues working and doesn’t enroll in Part B until she retires. She uses the Part B SEP to enroll in Part B May 1, 2019.
- Her ICEP is 3 months before her Part B effective date: February 1 – April 30, 2019.
- She enrolls in an Aetna Medicare plan effective May 1, 2019.
- MA OEPNEW for her begins the month of entitlement to both A and B (May) and continues through the last day of the 3rd month of entitlement to both Part A and Part B (July). Her MA OEPNEW runs from May 1 – July 31.
JSA is here to cover the ins-and-outs of the OEP so you are ready come January 1. Fill out the below contact form with any questions you may have!