Sales Opportunities During Lock-In

  • Originally published December 16, 2013 , last updated August 14, 2019
  • Medicare
Sales Opportunities During Lock-In

The great thing about the Annual Election Period (AEP) is that nearly every senior is a prospect for Medicare products, including Medicare Advantage and Prescription drug plans. After December 7, most agents work to resolve any remaining problems, take a break from the hectic pace of the AEP and lay out plans for the next year. So, what are your plans in the post-AEP time frame, also called the “lock-in"? Here are some opportunities to consider if you are active in the Medicare Advantage and Prescription Drug Plan market.

Five Star Plans – CMS has determined carriers that qualify for year-round selling of Medicare Advantage due to achieving five stars on their Quality Stars measurement. Is one near you?

Here is the CMS memo providing details on how the five-star program works.

Low Performing Plans – CMS has identified those plans rated less than three stars for three consecutive years and sent letters to the beneficiaries informing them they are eligible to switch to a higher performing plan through a one-time Special Election Period. This action, according to CMS, indicates a plan’s substantial failure to comply with its Medicare contract. A low-performing plan symbol is shown on Medicare Plan Finder. Clients are instructed to call 1-800-Medicare to switch to a higher performing plan. Low-performing plans are not permitted to enroll clients using online methods.

An agent is allowed to be paid by the carrer when his/her client switches to a higher-performing plan provided a completed Scope of Appointment form is completed prior to the client enrollment. Each carrier has unique requirements so check before having your client enroll through Medicare. CMS will likely send another reminder to the beneficiaries in February if they haven’t yet switched to a higher performing MA plan. Here is the original CMS letter to beneficiaries and a similar one was sent this year to beneficiaries enrolled in a low-performing plan.

Here are the health plans CMS targeted last year — encouraging 525,000 beneficiaries to switch plans!

SEP for Non-Renewals — Medicare Advantage members whose current plans are not renewing for 2014 are entitled to a Special Election Period (SEP) that runs from Dec. 8, 2013, to Feb. 28, 2014. This SEP relates specifically to members who are affected by plan or contract non-renewals and plan Service Area Reductions (SAR), effective Jan. 1, 2014.

Please note the following SEP effective dates:

  • Enrollment requests received from December 8 to December 31, 2013, will have an effective date of January 1, 2014.
  • Enrollment requests received in January will have an effective date of February 1, 2014.
  • Enrollment requests received in February will have an effective date of March 1, 2014.

Medicare Advantage Disenrollment Period (MADP) — Medicare Advantage plan enrollees have an annual opportunity to disenroll from any MA plan and return to Original Medicare between January 1st and February 14th of every year. The disenrollment period does not provide an opportunity to join or switch MA plans nor does it qualify for guarantee-issue Medicare Supplement. Regardless of whether the MA plan included Part D drug coverage, MA enrollees using this disenrollment period to disenroll from Medicare Advantage from January 1 through February 14 are eligible to enroll in a PDP too. Simply asking a Medicare Advantage member if they are happy with their plan choice may provide a sales opportunity.

Age-ins — Roughly three million baby boomers are aging into Medicare every year, or about 10,000 new Medicare prospects per month. Agents are routinely renting Turning 65 lists for mailings and/or phone calls (note there are cold-call restrictions for Medicare Advantage and Part D plans). Reputable list vendors should exclude prospects who are on the Do Not Call list too. Contact Senior Market Sales at 1-877-645-0147 if you are looking for compliant lists or mailers for the turning 65 market.

Dual Eligibles and Low Income Subsidy — Medicare Part A and Part B recipients who also qualify for Medicare Savings Programs or qualify for Medicaid benefits are considered Dual Eligibles. Those who qualify for Medicaid and/or Extra Help are also entitled to a Special Election Period (SEP) that allows them to switch plans outside the AEP.

For tips on how to help your low-income clients receive extra help, check out our blog series on Low-Income Subsidies.

What other opportunities exist? Many agents affiliated with Senior Market Sales have seen the value of our Lead Advantage Pro system, which is offered at no cost to the agent. With this internet-based technology, an agent can manage leads, perform quotes and utilize electronic methods of enrollment. SMS has two proprietary electronic methods permitting an agent to do business with clients in non face-to-face settings: App-by-Email and Agent Initiated Consumer Online Enrollment (AICOE). Both methods have undergone significant review by carriers and meet compliance requirements. Moreover, it permits an agent to become more productive and service clients in locations too far to drive. To learn more about Lead Advantage, call your marketer at 1-877-645-0147 or watch this training video.

Medicare Supplement — Many agents sell Medicare Advantage during AEP and then switch to Medicare Supplement during lock-in. Are the plans you represent competitive? Call SMS and make sure you are representing the right plans for 2014. It pays to compare and Senior Market Sales represents the top Medicare Supplement plans in the market.