The Medicare Advantage Open Enrollment Period (OEP) runs every year from January 1 to March 31. This a valuable time for agents and brokers to continue to assist clients with their Medicare Advantage Plans who may have missed the AEP window, but it’s critical to understand the rules to ensure you’re operating within compliance.
Captain obvious here, compliance isn’t optional.
As a licensed insurance agent, you need to know what you can and can’t do to stay compliant while serving beneficiaries. Failure to follow CMS guidelines will jeopardize your career, success, reputation, commission income and more.
Below I’ll break down the OEP guidelines, highlights compliant opportunities, and provides areas where you can train your team to maximize productivity and grow your agency.
What Agents CANNOT Do During OEP
No OEP-Specific Marketing
Agents cannot send marketing materials that specifically reference the Medicare Advantage Open Enrollment Period such as:
- Mailers, emails, or calls promoting the ability to change plans during OEP.
- Any materials encouraging beneficiaries to reconsider decisions made during the Medicare Annual Enrollment Period (AEP).
What to do instead: Focus on general messaging that supports clients’ health and insurance policy reviews.
Avoid Targeting AEP Switchers
If a beneficiary changed their Medicare Advantage Plan during the Annual Election Period, you cannot:
- Use purchased lists to target those individuals.
- Attempt to convince them to switch plans again.
Focus Area: Train agents to build relationships with current clients and identify new prospects, such as age-ins or those eligible for a Special Enrollment Period (SEP).
No Contacting Former Clients Who Switched Agents
If you find out a former client chose a new health insurance plan with another agent during AEP, you no longer have consent to contact.
Training Tip: Teach your team to prioritize client retention throughout the year to minimize plan changes. The only way to avoid this is through prevention, which is putting heavy attention to your customer experience.
No OEP-Centric Events or Ads
You cannot promote webinars, seminars, or ads that frame OEP as an opportunity to enroll in a new Medicare Advantage Plan.
Best Practice: Focus events on other opportunities, such as:
- Helping new beneficiaries during their Initial Enrollment Period (IEP).
- Educating clients on SEP options, like dual-eligibility or significant life events.
What Agents CAN Do During OEP
While restrictions are strict, there are plenty of compliant ways to connect with beneficiaries and offer value:
Assist Age-Ins
Beneficiaries turning 65 can enroll in Medicare Advantage Plans during their Initial Enrollment Period. This is a major opportunity for agents to connect with new-to-Medicare clients.
Action Step: Develop marketing strategies focused on age-ins to guide them through options like Medicare Part D, Medicare Supplement, and health coverage choices.
Discuss 5-Star Plans where Applicable
Top-rated Medicare Advantage Plans and Part D Plans with a 5-star rating allow for year-round enrollment. These plans are an excellent option to highlight during OEP discussions.
Training Tip: Make sure agents understand the benefits of 5-star plans and can explain their ratings effectively to beneficiaries.
Engage Dual-Eligible and LIS Beneficiaries
Beneficiaries who are dual-eligible for Medicare and Medicaid or those with a Low-Income Subsidy (LIS) can change plans once per calendar quarter during the first nine months of the year.
Focus Area: Train agents to identify dual-eligible clients and help them optimize their health coverage and drug coverage. Reminder, the LIS SEP is going away in 2025 in many states that do not have fully or highly integrated dual eligible plans (HIDE / FIDE). You’ll need to learn this process inside and out.
Respond to Beneficiary-Initiated Contact
If a beneficiary reaches out to your team with questions about their Medicare Advantage Plan, drug coverage, or general Medicare coverage, you are allowed to help.
Best Practice: Document all client-initiated interactions and provide comprehensive plan reviews.
Hold One-on-One Appointments
At a beneficiary’s request, agents can schedule individual meetings to review their current plans, discuss options, and provide education on alternatives.
Training Tip: Agents should focus on service, not sales. Discuss key topics like deductibles, provider networks, and additional benefits included in their health insurance plan that are specific to their needs.
Key Training Areas for Your Team
To make the most of OEP while staying compliant, focus on the following areas:
Compliance Education
Ensure your agents understand what’s prohibited during the open enrollment period and how to remain compliant when helping beneficiaries.
Client Education
- Train agents to prioritize education over sales.
- Help clients understand their Medicare Advantage Plans, Medicare Part D, and options for improving their health insurance coverage.
Special Enrollment Periods (SEP)
- Teach agents to identify SEP opportunities, like significant life events or dual-eligible clients in eligible states.
- Highlight options for clients facing unique circumstances, like disabilities or changes in health coverage.
Documentation
Ensure all beneficiary-initiated communications are thoroughly documented. Compliance depends on having clear records of how clients reached out for help.
Lead Generation Without Violations
Shift marketing to age-ins and clients seeking guidance on their insurance policy or plan benefits.
Final Thoughts on Serving Clients Compliantly in OEP
The Medicare Advantage Open Enrollment Period is an opportunity to deliver real value to beneficiaries while staying within the CMS rules. By focusing on client needs, like plan education, drug coverage, and addressing gaps in their current health insurance program, you’ll build trust and loyalty.
Train your team to be proactive and knowledgeable. When agents focus on education, service, and relationships, success naturally follows.
Need help creating a compliance-focused OEP strategy or training materials for your agents?
Reach out to your account manager, we’re here to help you maximize every opportunity!
