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Protecting the Consumer's Future

THE OEP

by Dawn McFarland

 The Medicare Advantage open enrollment period allows beneficiaries to make a change ONLY if they are enrolled in a Medicare Advantage plan.

The Medicare Advantage OEP occurs annually between January 1 and March 31. This is often confused with annual enrollment period (AEP), which runs from October 15 to December 7.  The OEP is ONLY for beneficiaries currently enrolled in a Medicare Advantage plan.

Beneficiaries can make one change during the OEP. Beneficiaries must proactively make the request to switch plans by contacting their agents. Here are the changes that can be made during OEP:

  • switch from one Medicare Advantage plan to another
  • disenroll from a Medicare Advantage plan and return to Original Medicare without a prescription drug plan
  • If you have a Medicare Advantage Prescription Drug Plan, you could switch to Original Medicare

There was some controversy regarding whether OEP should exist due to a concern involving churning. NAHU supported guardrails in the legislation to limit churn and prohibit poaching. Since the restoration of the OEP, Congress has received no complaints, and agent and beneficiary satisfaction has remained high.

The OEP was first passed as part of the Medicare Modernization Act, which had allowed beneficiaries to make a one-time plan change between January and March of each year to another MA plan. Because these plans were so new, it was deemed important to ensure beneficiaries understood their plans and were satisfied.

The ACA took away this option in 2010 and replaced the OEP with the Medicare Advantage disenrollment period, which ran from January 1 through February 14. The notion was to make it easier to disenroll from an MA plan back to Original Medicare. Unfortunately for beneficiaries, Original Medicare became their only on option. It was clear that not all beneficiaries could qualify for or afford the added cost of a supplement.

NAHU embarked on a five-year lobbying odyssey to restore the OEP. Republicans during this time did not want to pass anything that would “improve” the ACA, while Democrats felt the law was perfect. Restoration to the OEP was finally made in 2018 as part of the 21st Century Cures Act.

Our job is to be sure our clients are aware of the marketing that will come at them and that we are available to clarify whatever questions they may have. We all know the commercials sound SO enticing, but they do not show the whole picture. Everything they say is true or it wouldn’t pass CMS requirements, yet they are misleading and frustrating to those of us trying to help clients understand what all of their options mean in terms of out-of-pocket costs and doctor access. Here is a direct quote from Medicare Advisory Council member Yolanda Webb: “It’s our responsibility as the agent to make sure our clients are aware of the information that they will be bombarded with and help them understand the accuracy of the information by knowing they have a resource they can trust.”

The Medicare Advisory Council has just developed an ad hoc committee to strengthen our relationships with additional agencies. There has been great progress, with Justin Lubenow working with CMS on the Medicare Plan Finder. Stay tuned for more information as we begin working with other agencies to continue to voice the role of NAHU agents and their importance for Medicare beneficiaries. In the meantime, continue being the beacons for those people navigating Medicare. What you do is valuable and important and that is evident by the gratitude of the clients we work with!

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