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Stay Busy after AEP – Frequently Asked Questions About SEPs

By December 17, 2019January 4th, 2021No Comments
special enrollment periods

While annual enrollment periods (AEPs) keep senior health insurance agents busy, special enrollment periods (SEPs) provide agents with additional sales opportunities during the traditional Medicare “offseason.” SEPs offer beneficiaries who experience a qualifying life event a certain amount of time to make changes to their coverage outside of their AEP. There are also certain circumstances where clients become eligible for a SEP that allows them to enroll or disenroll in Medicare Advantage (MA) and Medicare Part D policies.

So here’s the lowdown on special enrollment periods…

What is a SEP?

A Special Enrollment Period (SEP) allows a Medicare beneficiary to join, switch or drop their Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan (MA or MAPD or SNP) outside of the Annual Open Enrollment Period (AEP). If a client is eligible for a SEP, his or her coverage will be effective on the first day of the month following the new Medicare plan enrollment.

Where do I find SEP prospects?

When it comes to finding SEP business prospects, an excellent place to begin is the dual-eligible market. These are low-income individuals who qualify for both Medicare and Medicaid. Individuals who gain or have a change in dual-eligible status are granted a SEP. This allows them to join a plan within three months of the change, or their notification of the change (whichever is later). This group also has a SEP that allows them to change their Dual-Eligible Special Needs Plan (D-SNP) once during each of the first three calendar quarters of the year. Consider contracting with at least three D-SNPs, and be sure to take part in local training, to best cater to this market throughout the year.

What about new Medicare enrollees?

Don’t forget: Any of your clients who joined a Medicare Advantage plan during their initial enrollment period (around their 65th birthday) are given a 12-month SEP to disenroll and return to Original Medicare . In these cases, agents can use that time to recommend a Medicare Supplement (or Medigap) and prescription drug plan to go with their Original Medicare benefits.

Are there other circumstances that allow for SEPs?

Yes, there are several.

  • If Medicare terminates its contract with a client’s Medicare Advantage or Part D plan due to misconduct or other reasons, the plan must give your client 30-days’ notice before the termination date. The client then is eligible for a SEP, which will begin one month before the termination happens and lasts for two months afterward.
  • Any beneficiaries who recently moved out of their plan’s service area have a two-month SEP to enroll in a new plan offered in their new location. This SEP begins either the date of the move or the date the beneficiary notifies their plan of the move, whichever is later.
  • Part D SEPs are also quite common. These are triggered when a client whose prescription drug coverage through their employer health plan ends. When that happens, he or she has a two-month SEP to enroll in another Part D plan, beginning the day they lose coverage. Other times, your client may become eligible for Part D Low-Income Subsidy (LIS) or Extra Help. In this case, the client has an ongoing SEP to change Medicare Advantage-Prescription Drug or Part D plans on a monthly basis, provided they qualify for Extra Help. If the client loses Extra Help, he or she has a two-month SEP to change plans beginning the month they receive notice of the subsidy loss.
  • If a client lives in an area with a 5-star Medicare Advantage or Part D plan, and they’re eligible to enroll in that plan, they are given a SEP from December 8 through November 30 to join. The client can use this opportunity to enroll in a 5-star plan only once during the SEP. Medicare releases plan performance ratings each fall and the ratings apply for the following calendar year.

Using a local Medicare FMO company in North Carolina can help you make the most out of special enrollment periods. We want to see you succeed year round, and we are here to help. If you have any questions about SEPs or to talk more about how we can help you market SEPs to benefit you more, give us a call at 919-460-6073 or email info@carolinaseniormarketing.com.