With so many rules and regulations, Medicare enrollment periods and their associated guidelines can be challenging. Currently, there are four periods in which a client can enroll in a Medicare plan or change their current plan: the Initial Enrollment Period (IEP), Annual Enrollment Period (AEP), Open Enrollment Period (OEP), and Special Enrollment Period (SEP). Each enrollment period has unique requirements and restrictions for the agent and the client.
The IEP is specific for each person as it depends on their birthday. For people eligible for Medicare, the Initial Enrollment Period begins three months before their 65th birthday, includes their birthday month, and ends three months after their birthday, making their IEP 7 months. Seniors can sign up for Part A and/or Part B plans during this time. Retired seniors receiving government benefits (such as social security) are automatically enrolled in Medicare Part A without paying a premium. Employed seniors or those not receiving other government benefits must sign up manually. Medicare Part B requires the beneficiary to pay a premium closer to the traditional idea of health insurance. There are late enrollment penalties for Part A and Part B, respectively.
AEP officially lasts from Oct. 15 to Dec.7. However, seasoned Medicare agents and brokers know that the preparation for AEP can begin as early as June. AEP is the busiest time of year for Medicare agents, so it is vital to have a proper marketing plan in place. According to rules put in place by the Centers for Medicare and Medicaid Services (CMS), anyone selling Medicare or Medicare Supplements cannot directly advertise the AEP until Oct. 1. With this date being only two weeks before the AEP begins, finding new business during such a competitive time may seem difficult or even impossible. However, there are ways to warm up the market before any official marketing campaign due to CMS guidelines that differentiate between agent-to-client “communications” and “marketing” in the Medicare Communications and Marketing Guidelines (MCMG).
“Activities and use of materials to inform current and prospective enrollees. This means that all activities and materials aimed at prospective and current enrollees, including their caregivers and other decision makers associated with a prospective or current enrollee, are “communications” within the scope of the regulations at 42 CFR Parts 417, 422, and 423.”
“Marketing is a subset of communications that includes activities and the use of materials by the Plan/Part D sponsor with the intent to draw a beneficiary’s attention to a plan or plans and to influence a beneficiary’s decision-making process when selecting a plan for enrollment or deciding to stay enrolled in a plan (that is, retention-based marketing). Additionally, marketing contains information about the plan’s benefit structure, cost sharing, measuring, or ranking standards.”
Communication efforts should begin around mid-September to prepare current or prospective clients for AEP. However, it is important that agents and brokers understand what is and isn’t allowed in advertisements before October 1st.
According to the MCMG, communications and marketing are distinguished by “intent” and “content.”
Intent – the purpose of marketing activities and materials is to draw a prospective or current enrollee’s attention to a plan or group of plans to influence a beneficiary’s decision when selecting and enrolling in a plan or deciding to stay in a plan (retention-based marketing).
Content-based – on the exclusions in the definition of marketing and marketing materials and the type of information that would be intended to draw attention to a plan or influence a beneficiary’s enrollment decision, marketing activities, and materials include:
In other words, Medicare advertisements will be more vague before Oct. 1. However, there are also guidelines for the marketing period of AEP. For example, the MCMG states that marketing materials must state which plan year is being discussed in the ad (although current and prospective years can be marketed simultaneously), and brokers can only sell their plans to eligible beneficiaries for valid enrollment.
Additionally, sales and educational events may or may not need to be registered with each carrier to remain within the marketing guidelines; visit cms.gov for more information.
Additionally, the MCMG states that agents and brokers may not use door-to-door solicitation, approach potential enrollees in common areas unsolicited, or use telephonic solicitation. Many other specific guidelines are listed for agents and brokers to adhere to. For example, at sales or marketing events, refreshments and light snacks may be provided, but no item can be provided that may reasonably be considered a “meal.” However, meals may be provided at communications events.
OEP lasts from January 1st to March 31st and is more restrictive than AEP. This is because it is a secondary option for beneficiaries unhappy with the plan they chose during AEP.
Because of this, there are many marketing regulations when discussing OEP, and OEP cannot be discussed directly in advertisements or marketing strategies.
Agents CAN:
Agents CAN NOT:
SEP is reserved for special circumstances. Whether there is a global pandemic or a client moves into a new zip code, there are many instances in which a client may be eligible for a special enrollment period.
If a client moves outside of their plan’s service area to a new address, moves to a new address inside their plan’s service area that provides more or better options, returns to the United States after living in a different country, moves into, moves out of, or lives in an institution (such as a nursing home), or is released from jail, they are eligible.
If a client becomes ineligible for Medicaid, left their employer or union-supplied coverage, involuntarily loses coverage worse than Medicare or other coverage and is no longer eligible, left a Medicare cost plan that provided drug coverage, or canceled coverage in a program such as Program of All-Inclusive Care for the Elderly (PACE), they are eligible.
If a client can enroll in a new plan through their employer or union, is enrolling in a plan as good as Medicare prescription drug coverage, or is enrolled in PACE, they are eligible.
If Medicare makes a sanction because of a problem with a client’s plan that affects them or Medicare terminates the client’s plan’s contract, they are eligible.
Clients who are eligible for both Medicaid and Medicare, qualify for extra support paying for Medicare drug coverage, lose SPAP eligibility, enroll in a state pharmaceutical assistance program, drop a Medigap policy the first time they join a Medicare Advantage plan, have a disabling or severe condition addressed by a Medicare Chronic Care Special Needs Plan (SNP), enroll in an SNP but no longer have a qualifying condition, receive wrongful advice from a federal employee about joining or not joining a plan, are not informed that other private drug coverage is less beneficial than Medicare (or credible) drug coverage, or are not correctly informed about losing private drug coverage as good as Medicare drug coverage, are eligible.
In 2021 specifically, due to the coronavirus pandemic, the Centers for Medicare and Medicaid Services have extended access to the SEP until August 15.
Agents can indirectly inform their clients that AEP is coming up while following MCMG guidelines. This tactic of “warming up the market” is widely used, but it is essential to differentiate between “marketing” and “communications.”
Here are two examples of advertisements related to AEP:
Which one is marketing, and which one is communication? According to the CMS, No. 1 would be communication, while No. 2 would be marketing. No. 1 does not attempt to persuade the client to purchase any specific plan, while No. 2 attempts to convince the client to buy a plan from them by including the rate and specific benefits. Marketing for AEP is allowed starting October 1st, but beginning an awareness or communications campaign before then may benefit brokers and agents considering the competitive nature of AEP.
Begin planning your AEP marketing campaign here
Do not mention OEP in advertising or contact eligible enrollees unless the communication follows the OEP guidelines. If a potential enrollee requests explicit information about OEP, direct them to the call center.
Agents are not allowed to encourage clients to enroll in lower-rated plans during AEP under the impression that they can enroll in a higher-rated plan during SEP or OEP. Agents also cannot inform beneficiaries unhappy with their plan and have lower-rated plans that they are eligible to request a SEP and enroll in a higher-rated plan according to MCMG section 40.6.2. SEP is the most limited enrollment period in advertising.
Although this article is not an all-inclusive informational guide, these guidelines should guide the basic steps for your Medicare marketing campaign. Contact us today for more information on AEP, OEP, IEP, SEP, or Medicare.
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