What Is The OEP?
February 11, 2010
Denver CO
The Annual Election Period, during which Medicare beneficiaries can analyze and remake their Medicare coverage options, is followed by the Open Enrollment Period. The OEP lasts until the end of March.
This “second semester” of the Medicare year has become increasingly busy for those brokers and agents that deal in the Medicare realm. Many seniors become anxious as the final quarter draws to a close (my New Years Eve celebrations consisted of a large number of “last minute shoppers”!!) — and in some cases this is unnecessary as the January 1st to March 31st Open Enrollment Period still offers options. Let’s explore those for a minute::
First, a bit of review — the November 15th through December 31st period is called the Annual Election Period. During this period, a Medicare beneficiary can make significant changes to their Medicare coverages — i.e. changes to Medicare Advantage and Part D being the most notable.
The Open Enrollment Period lasts from January 1st through March 31st and is more restrictive. However, a beneficiary with a Medicare Advantage with Prescription Drug Plan (MAPD) can change to any other “like” plan one time during this period. (Think “apples-to-apples.” )
Changes to Part D prescription drugs plans are, however, substantially restricted. Stand alone Part D plans cannot be altered during the OEP.
That said, a beneficiary with a MAPD plan can change back to Original Medicare (that being parts A & B) and acquire a stand alone Part D plan. Moreover, someone with Original Medicare (which would include someone with a Medicare Supplement plan) can acquire an MAPD plan. There are other movement options as well, but I mention this because some of the anxiety created during the AEP is unwarranted.
After March 31st, what options are available to Medicare beneficiaries? Nearly all of these answers related to specific conditions that the beneficiary is experiencing. Here are some examples::
- A Medicare beneficiary has an MAPD plan. Since this type of plan is service area based (in general, service areas are geographically coincident with counties), when a person moves to another service area they have the option of changing to a plan that is availalbe in the service area of their new place of residence. This election period is an example of a Special Election Period. The timeframe for making this new selection is generally 60 days;
- A beneficiary is notified that the MAPD plan they have is being discontinued. This generates another type of SEP and permits the beneficiary to select another plan;
- A Medicare beneficiary is under a Medigap plan and just doesn’t like the coverage they have. The beneficiary can select a replacement plan from the same or another company, and make an appropriate application. The beneficiary needs to be aware that this new/replacement application can be medical underwritten and coverage can be denied. [note**there are state-by-state variations that may affect this situation]
R Allan Jensen
