Throughout the year, Medicare maintains several enrollment schedules, including the Annual Enrollment Period (AEP). AEP is a specific period of time when members can make changes to their Medicare plans. The annual enrollment period for Medicare is between October 15th-December 7th every year. Once AEP closes, members are not allowed to make changes until the following year, unless they qualify for an exception. Moving out of the service area could be one of the possible reasons for a member to qualify for an exception. Changes made by members during the Annual Enrollment Period go into effect January 1st of the next year.

Preparing Members for Annual Enrollment Period

During the Medicare AEP, members can alter their coverages under specific programs, such as Medicare Advantage, and Part D Prescription Drug plans.

In order to prepare members for AEP and to help them avoid stress and confusion, which may come during the Medicare AEP season, Health Plans should share with them these details:

  • Eligibility Check –  Members must primarily check if they are eligible to enroll in Medicare plans. If they are unsure, they can clarify their doubts by reading through the article, released by the US Department of Health & Human Services.
  • Analysis of existing coverage – Members should weigh the pros and cons of the specific plan they are in, the company/carrier of the plan, total expenses (including prescription meds) of the year. They should assess how quick their claims were paid and if their out-of-pocket expenses were worth the healthcare they received.
  • Note of Changes – Members should make a note of changes in medication or health, which could impact their plans. For instance – if the doctor prescribed a new medication or if there’s any treatment that wasn’t previously required when they set up their original plan.
  • Price Comparisons – While selecting the coverage for the upcoming year, it is essential to decide the type of Medicare beneficiary members are. Would they prefer to pay a little more monthly in exchange for peace of mind that they won’t have to bear any unexpected expenses? Or, would they rather pay a lower monthly premium and take the risk that their coverage may require high out-of-pocket expenses during a health issue?
  • Ongoing medication – Members must note their current medication, the dosage, frequency, and brand. This list would guide their Part D plan selection.

What Changes to Suggest Members during AEP? 

Here’s a quick rundown of what all you can suggest your members during Annual Enrollment Period:

  • Change from Original Medicare to a Medicare Advantage plan
  • Change from a Medicare Advantage plan back to Original Medicare
  • Switch from one Medicare Advantage plan to another Medicare Advantage Plan
  • Switch from a Medicare Advantage plan that doesn’t offer drug coverage to a Medicare Advantage plan that offers drug coverage
  • Switch from a Medicare Advantage plan that offers drug coverage to a Medicare Advantage plan that doesn’t offer drug coverage
  • Join a Medicare prescription drug plan (Medicare Part D)
  • Switch from one Medicare prescription drug plan to another Medicare prescription drug plan
  • Drop their Medicare prescription drug coverage completely

What to do in case of AEP window amiss?

Members often commit the mistake of thinking AEP as the only period to change their Medicare supplement plans. Contrary to it, Medicare supplement plans can be changed anytime throughout the year. Members must focus towards switching from or to a Medicare Advantage plan, and entering into or changing their prescription drug plans.

Also, you should make your members aware that they might end up being locked in a plan, wherein they are expected to pay a higher premium or witness holes in their coverage, in case of AEP window amiss (October 15th to December 7th). However, it is their Health Plans responsibility to analyze their existing plans, medications and ensure that they get the most cost-effective plan every year during AEP.

Medicare, however, allows changes outside the standard enrollment periods in specific situations that are often out of members’ control, such as Medicare ending its contract with a member’s plan, through Special Election Periods (SEPs). Other examples could be:

  • Moving out of the plan’s service area
  • Receiving both Medicare and Medicaid benefits
  • Qualifying for extra help
  • Member living in, moving to, or moving from an institution, such as a long-term care hospital or skilled nursing facility

On the whole, apart from sharing information on Annual Enrollment Period, it is for you to streamline all your member-facing communications and keep them happily engaged across omnichannel touchpoints.