Stay Busy Outside of AEP With Special Enrollment Periods

For senior health insurance agents, the bulk of business is done in the chaotic 54-day Medicare Annual Enrollment Period (AEP).

So, what’s an agent to do the other 311 days of the year? Hint: The answer isn’t take a long nap.

Taking full advantage of your clients’ Special Enrollment Periods (SEPs) must be your top priority to make the most of the Medicare lock-in period. SEPs offer beneficiaries who experience a qualifying life event a certain amount of time to make changes to their coverage outside of AEP. Under certain circumstances, your clients can get SEPs that allow them to enroll or disenroll in Medicare Advantage (MA) and Part D policies. This means you could be out selling and making money right now.

Which clients qualify for these nifty windows of opportunity? We’ll take a look at the most common triggers as well as get an idea of the various types of SEPs you’ll come across in a given year.

Listen to this article:

Where to Look First

Whether you’re an SEP novice or professional, one of the best places to look for SEP business is the dual-eligible market. Who’s dual eligible? Low-income individuals who qualify for both Medicaid and Medicare acquire this status. Anyone who gains or has a change in their dual-eligible status has an SEP allowing them to join a plan within three months of the change or their notification of the change — whichever is later.

They also have an SEP allowing them to change their Dual-Eligible Special Needs Plan (D-SNP) once per month if their Medicaid status and D-SNP enrollment meet certain criteria, like they are full-benefit dually eligible and enroll in an integrated D-SNP.

Whether you’re an SEP novice or professional, one of the best places to look for SEP business is the dual-eligible market.

Your client won’t switch their plan every month, but if they leave one plan for another, you want to be the agent who helps them. Savvy agents are contracted with at least three D-SNPs and take part in local training to best target this market at any time during the year.

Note: Utilization of the monthly integrated-care SEP is available only to facilitate aligned enrollment into integrated plans. Whether integrated D-SNPs are available and your clients can switch monthly will depend on your state’s Medicaid contracts. Please check with your state and carrier for details.

Time Is of the Essence

So, now you know clients in D-SNPs may be able to change plans every month. That makes one potential business avenue you can explore. But, what other SEPs might your clients be in the middle of right now?

One of the most common involves your clients who joined an MA plan during their Initial Coverage Enrollment Period around their 65^th birthday. Those clients have a 12-month SEP to disenroll and return to Original Medicare if they desire. If they do, you can offer them a Medicare Supplement (Med Supp) and prescription drug plan to go with their basic benefits.

Taking full advantage of your clients’ Special Enrollment Periods must be your top priority to make the most of the Medicare lock-in period.

On a separate matter, maybe you have a client who just moved out of their plan’s service area. They have a 2-month SEP to enroll in a new plan offered in their new residence area. This SEP begins either the date of their permanent move or the date they notify their plan of the move, whichever is later.

Or, lastly, your clients might be in either a Part D SEP or another unique SEP. However, since there are several ways your clients could qualify for one of these, we’ll address them in more detail next in their own section.

Part D SEPs

Part D SEPs are particularly interesting because they have several possible triggers. For example, you may have a client whose creditable prescription drug coverage through their employer health plan ends. If it does, your client has a 2-month SEP to enroll in a Part D plan, starting the day they lose coverage.

Additionally, you may have a client who becomes eligible for the Part D Low-Income Subsidy (LIS) or Extra Help. If so, they have an ongoing SEP to change MAPD or Part D plans on a monthly basis as long as they qualify for Extra Help. However, if your client loses their Extra Help, they have a two-month SEP to change MAPD or Part D plans starting the month they receive notice of the subsidy loss.

Unique SEPs

Many SEPs your clients could qualify for right now depend on specific circumstances within Medicare rules. These type of SEPs are possible anytime throughout the year and are at the discretion of Medicare or your clients.

If Medicare terminates its contract with your client’s MA or Part D plan because of misconduct and/or other reasons, the plan must give your client 30-days’ notice before the termination date. Your client will also receive an SEP, which will begin one month before the termination happens and last for two months afterward, to switch to another plan. In this situation, your client can choose to have their new MA or drug plan coverage begin up to three months after the month the previous plan ended.

Moreover, if your client is living in an area with a 5-star MA or Part D plan, and they’re otherwise eligible to enroll in it, they have an SEP from December 8 through November 30 to join that plan. Your clients 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.

Finally, if your client lives in a place impacted by an emergency or natural disaster, they may qualify for a disaster MA SEP. These SEPs depend on formal state or FEMA declarations and expire after varying lengths of time, depending on how long the formal declaration lasts.

Post-AEP SEPS

We’ve covered all the SEPs your clients could currently be in, however, there are some SEPs that just closed.

If your client is in an MA or Part D plan that’s terminating on December 31, they have an SEP to enroll in a different MA or Part D plan or return to Original Medicare. This SEP is from December 8 of the current year through the end of February of the next year. Note that this SEP gives your client another chance to enroll in an MA or Part D plan in addition to the AEP from October 15 through December 7, when they can switch, enroll in or disenroll from MA and Part D plans. Any plan changes made before December 31 are effective January 1, and those made after December 31 are effective February 1.

On another note, your client has an SEP to enroll in a Part D plan if they disenroll from an MA plan during the MA Open Enrollment Period (OEP), which runs from January 1 to March 31. This SEP starts when the client disenrolls from their MA plan using the MA OEP and ends at the close of the MA OEP or when the new Part D plan becomes effective, whichever is sooner.

Keep Up the Good Work

Even though AEP is likely your busiest season, there’s a lot more to the senior insurance market than those fall days. SEPs offer an abundance of opportunity for agents who are inclined to stretch a little out of their comfort zone.

If you’re willing to take the dive, start by reviewing your book of business to see which of your clients may qualify for SNPs or which have circumstances that may let them enroll in a new plan outside of AEP. And one last piece of advice: in addition to contracting with at least three D-SNPs, make sure you’re contracted with at least three of the most competitive Med Supp plans in your region. Med Supps don’t have an enrollment period, meaning qualifying clients can enroll at any time of the year.

Med Supp and Medicare Advantage plans are the big-ticket items in the senior health care market, make sure you’re ready to sell both.

Editor’s Note: This post was originally published in March 2016. It has been updated to reflect changes relevant to 2019.