The annual open enrollment period (OEP) for Medicare Advantage (MA) is here! OEP takes place from January 1 through March 31. During this time, individuals enrolled in an MA plan can make a one-time election to switch to another MA plan (with or without Part D coverage) or return to Original Medicare (with or without Part D coverage).
It’s important to know what to do and what not to do during OEP. To help you stay compliant, we have put together some helpful tips below.
During OEP, you can:
- Market to Medicare Advantage age-ins who have not yet made an enrollment decision.
- Market to D-SNP-eligible and LIS beneficiaries who, in general, may make changes once per calendar quarter during the first 9 months of the year.
- Send marketing materials when a customer requests information.
- Conduct one-on-one meetings at the customer’s request.
- Provide information about OEP through the call center if a customer asks.
During OEP, you cannot:
- Send unsolicited materials advertising or referencing OEP directly to your customers.
- Purchase mailing lists or other identifying information to specifically target customers during OEP.
- Engage in or promote activities intended to target OEP as an opportunity to make further sales.
- Call or otherwise contact customers who selected a new plan during AEP.
Disaster (DST) Special Election Period (SEP) Compliance
To ensure you stay compliant, we want to remind you of the Centers for Medicare & Medicaid Services (CMS) guidelines regarding the use of a DST SEPs throughout the year.
SEP for Government Entity-Declared Disaster or Other Emergency
42 CFR 422.62(b)(18)
(Rev. 2, Issued: August 12, 2020; Effective/Implementation: 01-01-2021)
An SEP exists for individuals affected by a disaster or other emergency declared by a Federal, state or local government entity who were unable to, and did not make an election during another valid election period. This includes both enrollment and disenrollment elections.
Individuals are eligible for this SEP if they:
- Reside or resided at the start of the SEP eligibility period where a federal, state or local government entity declared a disaster or other emergency.
- Were eligible for another election period at the time of the Disaster Election Period (DST) eligibility period.
- Did not make an election during that other valid election period due to the disaster or other emergency.
The SEP starts on the date the declaration was made or the incident start date whichever is earlier. The SEP ends two full calendar months following the end date identified in the declaration or the date the end of the incident is announced, whichever is later.
Please note when using DST SEPs:
- This does not mean that active marketing can occur.
- The SEP is only for the purpose of providing a SEP to impacted individuals who had a valid election during the incident and were unable to make that election due to the emergency.
- This does not mean that Cigna Healthcare initiates waiving of authorization or referral requirements.
- This does not extend waiving of prior authorizations, referrals etc.