Medicare Advantage Agents: Make the Most of the SEP Coming October 1

  • Originally published September 16, 2010 , last updated April 10, 2018
  • Medicare
Medicare Advantage Agents: Make the Most of the SEP Coming October 1

By some estimates, as many one million plan members will be affected this fall by Service Area Reductions or plan exits.

As you may already know, the impacted members will have the opportunity to participate in a Special Election Period (SEP), from October 1, 2010 to January 31, 2011, to help them migrate to another plan.

That is why it is more critical than ever this year to get contracted, certified and ready to sell as early as possible this year. Depending on where you live, Service Area Reductions or plan exits may cause you to have to service a significant portion of your book of business this fall. To help with this process, we’ve provided answers to some of the questions you and your clients might have about the Special Election Period (SEP).

Next Steps

October 2 — CMS-mandated Notification Letter
According to CMS regulations all impacted members must be notified of their plan’s exit by Oct. 2, 2010.

October 3 — Begin talking about 2011 plan benefits
Right now you can begin reaching out impacted clients and setting up appointments for October 3 and later, but you cannot acknowledge to members that their plan is closing (unless they’ve already been notified by the carrier) or talk about 2011 plan benefits until October 3, 2011.

December 31 — Existing coverage ends
If the enrollment request is completed by December 31, 2010, then the effective date of the new plan will be January 1, 2011. If enrollment request is completed in January 2011, the effective date will be February 1, 2011.

FAQs

When can agents tell a member their plan is closing?
Agents may not tell a member their plan is closing until after the member has been notified in writing by their Health Plan via the CMS-mandated Notification Letter (in-home 10/2/2010). Beginning 10/3/2010, agents may acknowledge to all impacted members that their plan is closing.

When can agents begin to market 2011 plan benefits?
Agents may not market 2011 plan benefits to the members impacted by a SAR/plan exit until 10/3/2010. There are no exceptions to this.

What types of things are considered "educational" that agents can start talking to their existing members about now?
Education includes objective, unbiased and factual information about Original Medicare, Medicare Advantage, Part D or Medicare Supplement plans, in general. Educational information cannot be plan-specific and should not steer, or attempt to steer, consumers toward a specific plan or limited number of plans.

What happens to the member's coverage if they don't do anything?
If the affected member does not take any action, their coverage will revert to Original Medicare effective 1/1/2011. Also, if a member has had drug coverage as part of their plan, they will no longer have drug coverage effective 1/1/2011, unless they have enrolled in a new plan that includes drug coverage.

If the member has a SEP through 1/31/2011, then what happens if the member doesn't sign up for a new plan until January?
Current plan benefits will only remain in effect through 12/31/2010. On 1/1/2011, the member will be covered under Original Medicare until the new plan takes effect on 2/1/2011. If a member has had drug coverage as part of their plan, they will no longer have drug coverage effective 1/1/2011 unless they have enrolled in a new plan that includes drug coverage.

Who should I contact if I have questions?
Contact your favorite Medicare Solutions marketer, or call the Medicare Advantage department directly at 1.800.786.5566.