The Medicare Advantage Open Enrollment Period (MA OEP) is notorious for having very strict compliance rules. However, there are still lots of opportunities to keep growing your book of business in the first quarter of the year.
Our team has put together a quick guide to help you through the compliance challenges during the MA OEP.
What Is the MA OEP?
From January 1 to March 31, Medicare Advantage (MA) enrollees have a limited opportunity to make changes to their coverage. During this time, individuals currently enrolled in an MA plan can:
- Switch to a different MA plan
- Disenroll from their MA plan and return to Original Medicare, with or without a Part D drug plan
Important: The MA OEP is only for individuals already enrolled in an MA plan. Those with Original Medicare and a stand-alone Part D plan cannot use this period to join an MA plan. They must wait for AEP or qualify for a Special Enrollment Period (SEP).
A few reminders:
- Only one plan change is allowed per beneficiary during this period.
- New coverage begins the first day of the month after enrollment (for example, a switch made on February 18 takes effect March 1).
- MSA plan enrollees do not have an MA OEP.
MA OEP Compliance Tips
During the MA OEP, the Centers for Medicare & Medicaid Services (CMS) prohibits agents and plans from knowingly targeting or sending unsolicited marketing materials related to the OEP (Medicare Communications and Marketing Guidelines).
You can't try to convince any individual to take advantage of the MA OEP by making an enrollment change. In simple terms, CMS does not want agents to use the OEP as an opportunity to make more sales.
Here are our top 5 compliance tips to ensure you don't accidentally break the marketing guidelines set by CMS.
1. Don't engage in any activities that intend to target the OEP.
CMS states in the MCMG, section 422.2263(b)(7), 423.2263(b)(7) that agents cannot engage in or promote any activities that intend to target the OEP as an opportunity to make further sales.
Here are a few examples of messages you cannot and should not send during the MA OEP:
- Unhappy with your new Medicare Advantage plan? Call us to learn more about your disenrollment options.
- Did you know you can switch Medicare Advantage plans from now through March 31st? Call me to schedule an appointment today.
- Got buyer's remorse? Call us to learn about other Medicare Advantage plan options with richer benefits.
These types of messages clearly target the MA OEP as an opportunity to make more sales, so they would break compliance rules.
2. Wait for client-initiated conversations before ever referencing the MA OEP.
While you cannot knowingly target the MA OEP as an opportunity to make sales, you can help clients who reach out to you with concerns or questions.
If a client comes to you and expresses they're not happy with their new Medicare Advantage plan, you can help them. You can also answer client questions related to enrollment opportunities and timelines.
Here are a few examples of client-initiated conversations:
- Am I locked into my current Medicare Advantage plan until October 15th, or can I make any changes before then?
- I'm not happy with the HMO plan I chose during AEP. Am I allowed to switch?
- Are there any other Medicare Advantage plans available in my county?
If a client starts any conversations like these, you can talk about the MA OEP. You can also send plan marketing materials and have a one-on-one meeting.
3. Don't use the OEP as an opportunity to reach out to clients you didn't see during AEP.
For agents with massive books of business, it's difficult to help everyone during the 54-day window that is AEP.
That said, you still cannot contact your own clients during the OEP to promote other plan options and try to generate some sales. This is a violation of CMS guidelines.
Remember: it's never compliant to target the OEP as an opportunity to make more sales—whether or not you're contacting your own clients.
4. Don't give up on all marketing activities during the MA OEP!
For fear of accidentally breaking a compliance rule, some agents stop all marketing activities during the MA OEP. They figure it's better safe than sorry, which we completely understand.
However, if you know the rules, you'll understand you can still conduct marketing activities with no fear of getting into hot water with CMS.
As long as you are not referencing the OEP or using the OEP as an opportunity to make further sales, you're good to go!
Here are some examples of things you can do during the MA OEP:
- Conduct marketing activities that focus on other enrollment opportunities, such as marketing to age-ins
- Send marketing materials when an individual makes the request
- Have a one-on-one meeting at a beneficiary's request (make sure to get a Scope of Appointment first)
5. Use Special Enrollment Periods (SEPs) to Help Clients
While OEP has strict marketing rules, SEPs create year-round opportunities to assist clients.
Certain life events like moving, losing employer coverage, or becoming eligible for Medicaid allow beneficiaries to make plan changes outside of AEP.
Since SEPs aren't tied to OEP, you can confidently educate clients about their options without breaking compliance rules. If you know a client may qualify, encourage them to check their eligibility.
Just be sure you’re focusing on their situation, not promoting plan changes for the sake of a sale.
6. Talk About 5-Star Plans (The Right Way)
5-star Medicare Advantage and Part D plans have a year-round SEP, allowing beneficiaries to switch to a highly rated plan at any time.
Read More: The 5-Star Enrollment Period: Marketing Tips for Medicare Advantage Agents
If a 5-star plan is available in your area, you can explain what makes it different and how the rating system works.
You just can’t present it as a way to switch during OEP or use language that suggests making a change because of the enrollment period.
7. Keep Recent CMS Rule Updates In Mind
While the MA OEP rules haven’t changed, CMS is doubling down on transparency and compliance. Here’s what that means for you:
- Keep records of client-initiated calls. If someone asks about plan options, log it before diving into details (just in case of an audit).
- Skip the sales pitch on prior authorizations. Faster approvals are great, but they can’t be used as a reason to switch plans.
- Check your digital marketing. Make sure your website, emails, and materials aren’t accidentally targeting OEP.
Bottom line? Stay focused on education, not sales tactics, and you’ll be in the clear.
8. Use our pre-approved Medicare Advantage marketing materials.
Our marketing team has developed fully compliant, CMS-approved Medicare Advantage marketing materials you can use any time of year.
This marketing material library includes:
- Flyers
- Desk displays
- Social media posts
- Postcards
Rest assured that every marketing piece has been cross-checked for compliance by two incredible organizations and is CMS-approved.
While you can't knowingly target people during OEP, you can conduct other marketing activities, such as reaching out to age-ins (typically people turning 65).
Our ICEP marketing materials are ideal to use during the first quarter, because they are entirely unrelated to the OEP and still help you grow your book of business.
Conclusion
While the Medicare Advantage Open Enrollment Period (MA OEP) has strict compliance rules, there are still ways to grow your book of business in Q1.
We hope this guide clears up any questions you have about the do's and don'ts of marketing during the MA OEP.
If you have any questions, leave a comment below!
