Compliance connection

(February 2021)

In this issue....

Check out the latest questions we're hearing from member calls to Medicare (CTMs). We have answers and examples to help you in different scenarios. Please use this information to evaluate and improve your sales processes. Topics in this issue include:

Who can use the OEP? 

Only those beneficiaries currently enrolled in a Medicare Advantage plan can use the OEP. Make sure you understand your enrollee’s current coverage status before reviewing plan options with them. During the OEP from January 1 - March 31, MAPD and MA-only members can switch to:

Who can’t use the OEP? 

Beneficiaries currently enrolled in a stand-alone PDP and those in original Medicare cannot use the OEP to change their plan.

Is there a limit to prospects' choices during the OEP?

MA/MAPD members can make only one plan choice during the OEP. Once they make their plan choice and their new plan takes effect, they can’t use the OEP again, even if it's before the March 31 deadline. Where possible, find out if your MA/MAPD member has already used their one plan choice during OEP.

Why should clients share their medication list when enrolling?

When discussing prescription drug coverage, explain to enrollees that sharing their medication list can help you determine which plan best meets their needs. Let them know that you can check to see if those medications are covered by the plan you're reviewing.

Remember, for some enrollees, collecting prescription bottles and reading labels can be difficult, so give them plenty of time to carry out this task.

Spending this extra time can help ensure that your enrollee is satisfied and confident in their plan decision.

When can a disaster/emergency SEP be used?

A disaster/emergency SEP is only applicable to those beneficiaries who were prevented from enrolling during a given election period due to a declared disaster or emergency.

CMS strictly limits when the disaster/emergency SEP may be used. To qualify for this SEP the enrollee:

  1. Must have had a valid election period during the time of the declared disaster/emergency; and
  2. Must have been unable to elect a plan due to the disaster/emergency. 

If these two conditions are not met, the enrollee may not enroll with this SEP.

Example: An appropriate use of a disaster/emergency SEP

Mr. X was eligible for a change of residence SEP due to his recent change in residence. Unfortunately, his new home was severely damaged by a wildfire shortly after his move. He was unable to enroll in a new Medicare Advantage plan during the election period. He is now eligible for a disaster/emergency SEP because:

 Example: An inappropriate use of a disaster/emergency SEP

Ms. X, a member residing in Portland, ME, and enrolled using the disaster/emergency SEP.  The use of this SEP was invalid because:

  1. No disaster/emergency was declared in the Portland area at that time and
  2. She had no other valid election period.   

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