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Medicare Part B eligibility

Medicare AEP vs. OEP

Because the Medicare enrollment periods can be so confusing, in this post we will explain the difference between Medicare AEP vs. OEP.    It is helpful to understand the different enrollment opportunities available to make any plan changes to help optimize your Medicare coverage.

Please note:  no one is required to change plans during either enrollment period.  It is purely optional.  It is however a good idea to review your plan benefits and consider all your options during AEP.

We will start with the AEP (Annual Enrollment Period):

In Medicare, these two enrollment periods have 2 different windows of time to enroll in a plan. To differentiate between the two, you need to know the dates available to make changes for each enrollment period.  The AEP runs from October 15 through December 7 each year.  During this period, Medicare enrollees have the opportunity to make many types of changes to their Medicare coverage.  These changes allowed during the AEP include:

1. Changing from one Medicare Part D (prescription drug plan) to another.
2. You can change from Original Medicare which may include enrollment in a Medicare Supplement and or a Prescription Drug Plan into a Medicare Advantage Plan.
3. If you are in Original Medicare, you may want to add a Part D (prescription Drug) plan.
4. Change from one MA/MAPD (Medicare Advantage Plan) to another.
5. Disenroll from a MA/MAPD (Medicare Advantage) Plan and enroll in Original Medicare.  This gives you the opportunity to enroll in a Supplement Plan as well as a Part D (Prescription Drug) Plan. (Medicare supplements may be subject to underwriting)

More information about AEP:

During the AEP, Medicare plan providers use the enrollment period to announce plan updates and changes to their benefits for the following year.  These changes may include plan costs, deductibles, co-pays and coinsurance amounts. The carries send out their ANOC (annual notice of change) to their beneficiaries in hopes that they can add beneficiaries and grow the strength of their plan.  Once enrollees get their ANOC, they can decide whether to keep their current plan or consider making a change.  The AEP is the best time to compare plans and make sure you are enrolled in the plan that provides the coverage options you are looking for.

AEP allows you to make several plan changes.  Keep in mind, the last plan change you make is the one you will be enrolled in.  The plan you enroll in during AEP will begin January 1st of the following year.

Now we will discuss the OEP (Open Enrollment Period):

The OEP (Open Enrollment Period) is sometimes referred to as the MAOEP or Medicare advantage Open Enrollment Period., This enrollment period runs from January 1 through March 31 each year. The OEP differs from the AEP because only members of MA/MAPD (Medicare Advantage Plans) are able to make plan changes during this enrollment period. Member cannot change Original from Original Medicare/Medicare Supplement plans or switch from one PDP plan to another. Only changes to Medicare Advantage plans is permitted.

Enrollees of Medicare Advantage plans can make the following changes:

1. Switch from one Medicare Advantage plan to another one that provides the coverage you need.
2. Dis-enroll from you current Medicare Advantage plan and enroll in Original Medicare (this may include a supplement and PDP plan).

One important difference between the AEP and OEP is that; you may make one plan change during the OEP and that is all.  OEP is also a good time to correct any MA/MAPD plan changes you made during AEP that you are not happy with.  Any changes made during OEP will go into effect the month after your application is submitted.

Be aware that once you make a plan change during OEP/MAOEP you will not be able to make changes until the next AEP.  This rule does not apply to individuals with an SEP.

Learn more about the Medicare Advantage Open Enrollment Period

Please note:

Beneficiaries of Medicare Supplement (Medigap) plans are not subject to either of these enrollment periods.  They have their own enrollment rules.

Are you a Medicare agent?  Learn why you should join the team at Crowe and Associates

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Medicare agent application checklist

If you are a Medicare agent, you know there are some things you need to do to prepare before taking an application from a client.  Take a look at the suggestions in the Medicare application checklist below. are currently taking as well as their doctors. This is all important information that you need to run an accurate Medicare quote.

You can easily run a quote using one of our free online quoting and enrollment tools such as Sunfire or Connecture.  Both of these tools have a built in CRM that is free to use to our contracted agents.

Learn more about how to quote Medicare Advantage plans with our free quoting tools

Before you take the application

Be sure you get a signed SOA.  There are CMS guidelines agents must follow when taking a SOA.  Agents must take the SOA (Scope of Appointment) 48 hours before you meet your client to sign up for a Medicare plan.  Please note; a scope is good for 12 months from the date the client signs it.  After a 12-month period, you need a new scope signed before any Medicare enrollment discussions can take place.  You must keep a scope of appointment on file for 10 years weather or not you made a sale. per CMS guidelines.

Watch our YouTube video on Scope of Appointment rules starting 10/1/23

Click here to download a generic scope

It is important that the SOA is filled out correctly with the plan type that you are discussing during your meeting checked of or initialed.  There are a few ways to collect the SOA.  You can collect it on the phone, via voice recording, online by sending a link either by email or text and you can also collect a paper SOA.  This all depends on the client’s preference.

Using a paper application

It is important to write legibly in either black or blue ink.  This ensures what you submit is processed without delays.

1. If your client is enrolling in an MA/MAPD plan, be sure to include their PCP name and ID information requested on the enrollment form.  This is extremely important if they are applying for an HMO.  You should always check the client’s list of providers before enrolling them in any MA/MAPD plan.
2. In the event your client has to answer health questions, make sure they provide detailed explanations for any health questions they answer yes to.
3. If the client is enrolling during an SEP, be sure to include any necessary or required information.  If you try and skip this, it will only delay the processing and can result in a denial or enrollment.
4. Be sure the that not only the client signs wherever required but that you sign where needed as well. This goes for the scope of appointment too.
5. Submit the application on time.  Know the carrier rules for how long after you receive the application it must be submitted by.
6. Before submitting the application check everything over one last time so that there are not delays in processing and the client gets the coverage they need on time.  If you send you r application through Pinnacle, they will scrub it for you, but it is always better to double check before submitting it to them.

Submit the application electronically

One way to be sure the application is done correctly is to use one of our free online enrollment tools and submit the application electronically.  This will ensure that all information is provided, and that the application is filled in legibly.

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