MA Annual Enrollment vs. Open Enrollment

Oct 29, 2007

  1. glenwmr
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    glenwmr New Member

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    Hello all, I've never posted, but have read and learned LOTS... so thanks to everyone who posts in this forum.

    I'm in Dallas, TX and new as an independent agent. I've worked in health insurance for over 8 years, just not as a broker. So, here's a question I have:

    For MA plans, what is the difference between the annual enrollment period (Nov 15th - Dec 31st), and the open enrollment period (jan 1 - mar 31st)? Who are the different types of people to market to during these periods?

    Why do people call this time the "selling season"?

    As a new agent, am I basically unaffected by this period this year because I have no current clients that would want to change plans at this point?

    Thanks for any help!

    Mark
     
    Last edited by a moderator: Oct 29, 2007
    glenwmr, Oct 29, 2007
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  2. GreenSky
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    GreenSky Guru

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    AEP allows people to do anything they want. The OEP allows people to make like for like changes.

    As an example, if someone did not buy a PDP a year ago, they can get one (with penalty) during AEP. But once Dec. 31 passes, they cannot get a plan during the OEP.

    If someone already has an MAPD and it's Jan 15, then they can change into another MAPD, an MA and a PDP, etc. No new coverage, just a change in coverage.

    The selling season is just that. Nov 15 - Dec. 31 and then Jan 1 - Mar. 31. Each and every one of us makes so much money in the 4 1/2 months that we don't need to work the rest of the year:cool:.

    Rick
     
    GreenSky, Oct 29, 2007
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  3. senior-advisor-indiana
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    senior-advisor-indiana Guru

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    I only worked 4 and 1/2 months a year before PFFS plans. :)
     
  4. Kimber
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    Kimber Super Genius

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    I agree with Rick, but also please note that after January 1 the client can only make one change. Up to December 31, the last app processed by CMS is the one which sticks, however after Jan 1, it is the first one which "wins" the business for the benefit year.
     
    Kimber, Oct 31, 2007
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  5. retread
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    retread Guru

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    Glad you pointed that out, Kimber. I think this went over the head of many out there, at least from the conversations I overheard this year. It is amazing how little attention some agents give to the wording in regulations. I know we are not all lawyers, but it is incumbent on us to do our due diligence and READ THE RULES CAREFULLY!
     
    retread, Oct 31, 2007
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  6. glenwmr
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    glenwmr New Member

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    Great Info! Thanks for replying. So, let's see if I got it?

    AEP - 11/15 - 12/31

    Example: Somone is on a med supp and wants to enroll in an MA plan. They enroll in the MA plan, and discontinue their Med Supp premiums (if they want -- I know they don't have to technically terminate their Med Supp).

    Example: Someone just on original Medicare wants to select an MAPD plan. They can during this time.

    OEP - 1/1 - 3/31

    Example: Someone with SecureHorizons wants to change to Humana because they don't like the service they receive when they call customer service.

    Example: Someone with the ANY ANY ANY plan wants to come off the PFFS plan because their hospital does not accept the plan, and they want to get an MAPD PPO plan through Aetna.

    Do I have it???
     
    glenwmr, Oct 31, 2007
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  7. retread
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    retread Guru

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    Yes... as long as the PFFS plan had a drug benefit (MAPD), because a PPO will always have a drug plan (MAPD). Some PFFS plans are MA only, so be careful there.
     
    Last edited: Oct 31, 2007
    retread, Oct 31, 2007
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  8. glenwmr
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    glenwmr New Member

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    I see. So, it truly has to be a like-like change during open enrollment. They can't go from a plan without prescription drugs to a plan with prescription drugs. Suppose, they were on a PFFS without any prescription drug coverage, and they wanted to get on a MAPD, would that have to take place during the AEP?

    I know this is a technical, boring question, so I appreciate you taking the time to show me the ropes!

    I also see the other thread "Like to Like - OEP" going on as well... that is somewhat helpful. (I think.)

    Mark
     
    Last edited: Oct 31, 2007
    glenwmr, Oct 31, 2007
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  9. Guest
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    Guest Guest

    I was told that by law you can't have both an MA and a Supp.

    Did I receive bad information? Or are the benefits co-ordinated?

    Al
     
    Guest, Nov 1, 2007
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  10. honestagent
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    honestagent Guru

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    Al, you are correct. As of 07, (haven't read 08 publication on this yet) they can keep their med. supp why they try out a med. advantage but they will get very little or no use out of it. Mostly no use. The purpose is for them to maintain their premiums and if they don't like new program, they can disenroll (during non lock in times) and they'll still have their med sup with no gap of coverage... so if something happens during the interum of the drop - they have insurance!!!!

    but yeah, you CANNOT have both; it's one or the other. and in terms of coordination - off topic - like group retirement bennies... wow be careful because even if you call and they say the do coordinate, most of them still do not. had a few clients where we called, the blues said they do, they even wrote a letter stating they do, and they ended up not coordinating. Good rule of thumb, if they have a good group plan, leave em there... unless they want out. This is b/c if they leave the group, they are not guarantteed to come back should they want to down the road. Thought I'd throw this in too since we're talking about coordination of benefits.

    Does this help you? As for 08, cannot say yet. Haven't had a chance yet to read up on it but will soon.
     
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