For senior health insurance agents, the Medicare Annual Enrollment Period (AEP) is a whirlwind 54 days of non-stop business. But what about the other 311 days of the year? Spoiler alert: the answer isn’t taking a long vacation.
Making the most of your clients’ Special Enrollment Periods (SEPs) should be a top priority during the Medicare lock-in period. SEPs provide eligible beneficiaries, who experience a qualifying life event, with a limited window to make changes to their coverage outside of AEP. These windows allow clients to enroll in or disenroll from Medicare Advantage (MA) and Part D plans under specific circumstances. For agents, this means plenty of opportunities to stay busy and continue earning throughout the year.
Curious about which clients qualify for these valuable opportunities? Let’s explore the most common triggers for SEPs and the various types you’re likely to encounter during the year.
Start with the Dual-Eligible Market
Whether you’re new to Special Enrollment Periods (SEPs) or a seasoned pro, the dual-eligible market is one of the best places to find SEP business. Who qualifies as dual-eligible? These are low-income individuals who are eligible for both Medicaid and Medicare.
If a person gains dual-eligible status or experiences a change in their status, they qualify for an SEP. This allows them to join a plan within three months of the status change or their notification of it—whichever comes later. Additionally, those who meet certain criteria, such as being full-benefit dually eligible and enrolling in an integrated Dual-Eligible Special Needs Plan (D-SNP), can use their SEP to switch D-SNPs once per month.
Your clients won’t change their plan every month, but when they do decide to switch, you’ll want to be the agent guiding them through the process. Smart agents ensure they’re contracted with at least three D-SNPs and actively participate in local training. This approach positions them to effectively target the dual-eligible market year-round.
Important Note: The monthly integrated-care SEP can only be used to facilitate aligned enrollment into integrated D-SNP plans. The availability of integrated D-SNPs and your clients’ ability to switch plans monthly will depend on your state’s Medicaid contracts. Be sure to verify details with your state and carrier before proceeding.
Time Is of the Essence
Now that you know clients enrolled in D-SNPs may have the option to switch plans monthly, you’ve identified one potential avenue for business. But what other SEPs might your clients qualify for right now?
A common SEP involves clients who joined a Medicare Advantage (MA) plan during their Initial Coverage Enrollment Period (ICEP) around their 65th birthday. These clients have a 12-month SEP during which they can disenroll from their MA plan and return to Original Medicare if they choose. If they do, this presents an opportunity to offer them a Medicare Supplement (Med Supp) plan and a prescription drug plan to pair with their Original Medicare benefits.
Maximizing your clients’ Special Enrollment Periods should be a top priority to make the most of the Medicare lock-in period.
Another scenario involves clients who have recently moved out of their plan’s service area. These individuals have a three-month SEP to enroll in a new plan available in their new location. If they notify their plan before moving, the SEP begins one month prior to their move and continues for two full months afterward. If they notify their plan after the move, the SEP begins the month they notify the plan and lasts for two additional months.
Finally, your clients might qualify for a Part D SEP or another unique SEP. Since there are several ways clients can be eligible for these, we’ll dive into those details in the next section.
Part D Special Enrollment Periods (SEPs)
Part D SEPs are particularly noteworthy because they can be triggered by various circumstances. For example, if a client loses their creditable prescription drug coverage through an employer health plan, they are eligible for a two-month SEP. This SEP begins either on the day they lose coverage or the day they receive notice of losing coverage—whichever occurs later—allowing them to enroll in a Part D plan.
Another trigger involves clients who qualify for the Part D Low-Income Subsidy (LIS) or Extra Help. If your client becomes automatically enrolled due to Medicaid or a Medicare Savings Program (MSP), they gain an SEP to enroll in, drop, or switch Medicare Advantage (MA) or Part D plans starting the month they become eligible. This SEP allows them to change plans once per month as long as they qualify.
For clients who apply for Extra Help and are approved, they also gain an ongoing SEP, enabling them to join, drop, or switch Part D or MAPD plans monthly. However, if they lose their Extra Help status, they receive a three-month SEP to switch MAPD or Part D plans. This SEP begins on the date they lose eligibility or the date they are notified of the loss—whichever is later.
These SEPs offer clients flexibility and ensure they have access to the coverage they need, while providing agents with ongoing sales opportunities.
Unique Special Enrollment Periods (SEPs)
Certain SEPs are triggered by specific circumstances outlined in Medicare rules, offering clients opportunities to make changes to their coverage throughout the year. These SEPs depend on Medicare’s discretion or your clients’ unique situations.
- Contract Termination SEP: If Medicare terminates its contract with a client’s MA or Part D plan due to misconduct or other reasons, the plan must provide 90-calendar-days’ notice before the termination date. In such cases, your client qualifies for an SEP that begins two months before the termination date and lasts for one month afterward, allowing them to switch to another plan.
- 5-Star Plan SEP: If a 5-star MA or Part D plan is available in your client’s area, and they meet the eligibility criteria, they can use a SEP to enroll in that plan. This SEP runs from December 8 through November 30 and allows a one-time switch during the period. Medicare releases updated plan ratings each fall, which apply to the following calendar year.
- Disaster SEP: Clients impacted by emergencies or natural disasters may qualify for a disaster-related MA SEP. These SEPs are tied to formal declarations by the state or FEMA and vary in duration based on the length of the official declaration.
These unique SEPs provide valuable opportunities for clients to adjust their coverage when unexpected events occur, while also creating year-round sales opportunities for agents.
Post-AEP Special Enrollment Periods (SEPs)
While we’ve discussed the SEPs your clients might currently qualify for, it’s also important to understand some SEPs that have recently closed or are transitioning.
- Contract Termination SEP: If your client’s Medicare Advantage (MA) or Part D plan contract ends on December 31 and is not being renewed, they qualify for an SEP. During this time, they can enroll in a different MA or Part D plan or return to Original Medicare. This SEP runs from December 8 of the current year through the end of February of the following year.
This SEP provides an additional opportunity for your client to make plan changes outside the Annual Enrollment Period (AEP), which runs from October 15 to December 7. Changes made before December 31 become effective on January 1, while changes made after December 31 take effect on February 1.
- MA OEP and Part D SEP: Clients who disenroll from an MA plan during the Medicare Advantage Open Enrollment Period (OEP) are also eligible for a related SEP to enroll in a Part D plan. The MA OEP runs from January 1 to March 31, and this SEP begins when the client disenrolls from their MA plan and ends either when their new Part D plan becomes effective or when the OEP concludes—whichever happens first.
These SEPs ensure clients have additional opportunities to adjust their coverage as their needs or circumstances change, even after the busy AEP has ended.
Keep the Momentum Going
While AEP may be your busiest season, there’s far more to the senior insurance market than just those fall months. Special Enrollment Periods (SEPs) provide a wealth of opportunities for agents ready to step beyond their comfort zones and expand their reach.
To get started, review your book of business to identify clients who may qualify for Special Needs Plans (SNPs) or who have circumstances that could allow them to enroll in a new plan outside of AEP. Additionally, make sure you’re contracted with at least three D-SNPs to meet the needs of dual-eligible clients effectively.
It’s also a smart move to contract with at least three of the most competitive Medicare Supplement (Med Supp) plans in your region. Since Med Supps don’t have a restricted enrollment period, qualifying clients can sign up at any time, giving you a consistent year-round sales opportunity.
Medicare Advantage and Med Supp plans are the cornerstone products of the senior health care market. Make sure you’re well-prepared to sell both and continue growing your business all year long!
Not affiliated with or endorsed by Medicare or any government agency.
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