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Prepare for AEP

Prepare for AEP early.    As an independent insurance agent, Fall can be one of the most stressful times of the year due to the Annual Enrollment Period. But it doesn’t have to be! Although it will still be busy, there are four easy steps you can take now to ensure you’ll feel more prepared by October 15th. With these steps, you’ll be ready to capitalize on the biggest Medicare Advantage sales period of the year.

Prepare for AEP – Take time to review and choose carrier plans

This is the moment to take stock of your portfolio. Which carriers are you representing? Which of their plans have sold the best for you in the past? What do you have to offer new and returning clients? An agent should be familiar with the ins and outs of the plans they offer, including the benefits, costs, and applications so that you can meet the needs of your clients.

Prepare for AEP -Get ready to sell

Make sure that the basic requirements that you need to have met in order to legally and ethically sell Medicare Advantage have all been met. AEP is no time for surprises! Are your carrier certifications all completed? Is your AHIP exam completed and passed? Have you familiarized yourself with the new regulations from the Center for Medicare and Medicaid Services (CMS)? It is vital that you be in compliance with all certifications, exams, and regulations in order to sell Medicare products.

Prepare for AEP -Gather resources and marketing tools

AEP can go much more smoothly if you partner with an FMO, or a Field Marketing Organization. They often offer their agents and partners access to many free marketing tools and resources, like event planning, reimbursement for certain purchases that go towards marketing, compliance support, online portals for data analysis and platforms for call recording, and even teams of people whose job it is to support your sales.

Look at the data

This is a good time to look at the numbers from previous AEPs. Are there certain demographics you do particularly well with? Do you have some plans in your portfolio that haven’t sold well in a few years? Look for trends and patterns and use them to identify strengths and areas of improvement to focus your energy on during this AEP.

With these steps, AEP may seem much less stressful than previous years, and maybe even much more exciting.

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 Medicare Advantage Year in Review

In nearly every line of work, circumstances can evolve and change at a rapid rate. In the Medicare field, there are so many moving parts because of the involvement with the federal government, assorted agencies, state governments, and private insurance carriers, it is vital to review the data from previous years to see what the rundown is. This can help inform savvy agents as to what to expect from the coming year as well as offer valuable perspective. These are some of the key trends and takeaways from Medicare Advantage in 2023.  Here is the Medicare Advantage year in review.

MAPD

• More than half of the people eligible enrolled in Medicare Advantage (MAPD) for 2023. That’s approximately 51% of beneficiaries, or 30.8 million people. As a piece of the eligible Medicare population, that means that that figure has jumped up by 19% in 2007 to 51% in 2023. Since 2022, the population enrolled in Medicare Advantage has increased by 8%. In the next decade, the percentage is expected to rise to over 62% enrolled in Medicare Advantage.

• One in five beneficiaries of MAPD are enrolled in a plan offered by a union or an employer. That is about 5.4 million people, or about 20% of the population. In the following five states, the group enrollees counted for a third or more of all enrollments: Alaska, Michigan, New Jersey, Maryland, and West Virginia.

• In the past five years, enrollment in Special Needs Plans (SNPs) has doubled. This means than 5.7 million Medicare beneficiaries are enrolled in special needs plans.

• Two private insurance carriers, Humana and UnitedHealthcare, account for nearly half of all Medicare Advantage (MAPD) enrollment nationwide. Together, the two companies account for about 47% of Medicare Advantage enrollment

This brief overview of some of the more variable statistics from this year may help agents to plan ahead for the future. For instance, the market for Medicare Advantage plans is expected to continue to grow. What can you do now to optimize your business?

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Medicare Special Enrollment Periods

While Medicare Annual Enrollment Period is only for several weeks out of the year (October 15 to December 7), there are certain events that qualify beneficiaries for enrolling in Medicare coverage outside of that time period. Chances to make a change to coverage are called Medicare Special Enrollment Periods (SEP). There are different rules that govern what beneficiaries can do depending on the type of qualifying event.

The most common qualifying life events that result in a special enrollment period are the following:

Change of residency

Sometimes, moving living locations results in a special enrollment period because the new residence is no longer in range for the coverage that the previous plan provided. When this happens, the beneficiary must notify the plan’s carrier. If the beneficiary notifies, then they will have about a two month window to make adjustments to their coverage, like choosing a new plan. If they do not choose another Medicare Advantage plan, they will be enrolled in Original Medicare when they are disenrolled from their previous plan.

Loss of current coverage – Medicare Special Enrollment Periods

This most often occurs when a beneficiary is enrolled in Medicaid and then is no longer eligible due to changing life circumstances like increased income or loss of disability status. The beneficiary can then switch to Medicare Advantage, drop the Medicare Advantage plan and return to Original Medicare, or drop the coverage that they previously had without making other changes. This will result in a lapse in coverage.

Opportunity for other coverage

A beneficiary can drop their Medicare Advantage plan and/or Part D plan if  an opportunity for other coverage arises.  Offers include as an insurance plan offered by or subsidized by a union or employer.  This special enrollment period can occur whenever the beneficiary is offered alternative coverage.

Plan changes its contract with Medicare

Sometimes, Medicare takes an official action called a sanction to protect beneficiaries. If sanctions occur, the contract the insurance carrier has with Medicare will be different and those differences will affect the plans that beneficiaries are enrolled in. If this happens, the beneficiary can enroll in a different Medicare Advantage plan offered by the same or a different carrier.

Other special circumstances – Medicare Special Enrollment Periods

There are multitudinous other circumstances that may result in a special enrollment period for beneficiaries. Some of them could be being eligible for both Medicare and Medicaid, qualifying for the Extra Help Pharmaceutical prescription drug coverage, qualifying for a Special Needs Plan and choosing that coverage instead, and the list goes on.

Regardless of the specifics of the beneficiary’s circumstances, a qualifying life event that results in a special enrollment period is an opportunity to get better, more comprehensive and appropriate care.

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Medicare Enrollment Periods 2023

CMS regulates when beneficiaries can change Medicare Advantage and PDP plans.   This article addresses Medicare enrollment, not MAPD/PDP enrollment.

General Enrollment Period 

The General Enrollment Period (GEP) runs from January 1 through March 31. Coverage begins the first of the following month for beneficiaries enrolling  in Medicare during the GEP.  In previous years, coverage did not begin until July 1.

Initial Enrollment Period 

The Initial Enrollment Period (IEP) is the seven-month period.   Medicare beneficiaries can enroll 3 months prior and up to 3 months after their  65^th birthday month.  IEP includes three months before, the month of, and three months after someone’s 65^th birthday month.  Prior to  2023, people who enrolled in Medicare during the last three months of their IEP had to wait up to three months for coverage to begin.   That is no longer the case.   Coverage is effective the first of the month after the month of enrollment.

Special Medicare Enrollment Periods 2023

CMS established Special Enrollment Periods (SEPs) for Part B and premium Part A for those with an exceptional circumstance. SEP allows expand Medicare enrollment opportunities, reduce gaps in coverage, and prevent late enrollment penalties.

ISEP – New to Part B

This election period applies to beneficiaries new to Part B.  Side note:  a MAPD/PDD application must be submitted prior to the Part B effective date in order to use the ISEP.

SEP – Emergency or Disaster

This special election period offers beneficiaries that missed an enrollment opportunity due to a government declared an emergency.   FEMA disasters are an example.  Click here for additional disaster SEP information. 

SEP for  Loss of Coverage 

An individual can use this SEP if their employer, employer plan, or someone acting on behalf of their employer gave them incorrect information that caused them to delay Medicare enrollment.  In addition, this SEP applies when an individual loses group coverage.   CMS allows a full 2 months for enrollment after the loss of creditable coverage.

SEP for Formerly Incarcerated Individuals

This SEP is for individuals who are released from incarceration on or after January 1, 2023.   Formerly incarcerated people may be eligible for a Special Enrollment Period to enroll in Premium Part A and Part B. They won’t have to pay a late enrollment penalty if they enroll using the SEP.

Coverage start date is the first day of the month following the month of enrollment.   Alternately, retroactive coverage can be requested up to 6 months in the past.  Note: retroactive premiums apply.

SEP to Coordinate with Termination of Medicaid Coverage

This SEP, also called the Medicaid SEP, is for people who lose Medicaid eligibility.   CMS allows a change for 3 months from either the day of ineligibility or notification, whichever is longer.

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