Keep Your Momentum Going Around AEP With Special Enrollment Periods



The 54 days of AEP is when most agents collect the majority of their business, however the remaining 311 days of the year still offer ample opportunity in the form of Special Enrollment Periods (SEPs).

This time period offers Medicare beneficiaries the opportunity to switch their Medicare Advantage (MA) and Part D plans, giving you, the agent, the ability to continue selling outside of AEP and continue adding commissions!

So how do you find these opportunities to make money during SEP? We'll discuss this more below.


Best Place to Start Looking for SEP Business

One of the best places to start looking for potential business during SEP is in the Dual- Eligible market. This market is for low- income individuals who therefore qualify for both Medicaid and Medicare. Any beneficiary carrying a Dual- Eligible title is eligible for a SEP allowing them to change their Dual- Eligible Special Needs Plan (D-SNP) once during each of the first 3 calendar quarters of the year. Along with that, any individual gaining new eligibility or with an eligibility status change, is also in a SEP period, allowing them to join a plan within the 3 months after their change in eligibility.


Timing is Paramount with SEPs

Dual Eligible individuals are a great resource for new client enrollments, but what are some of the other potential SEP- eligible beneficiaries to keep an eye out for?


  • MA Clients Who Move to Traditional Medicare:

One of the most common types of SEP- eligible clients are individuals who enrolled into a Medicare Advantage plan when they turned 65 and now want to change to traditional Medicare. These clients have a 12 month SEP to disenroll from their MA plan and move to traditional Medicare. This gives you the opportunity to enroll them into a Medicare Supplements and/or Part D plan as well.

  • Client Who Recently Moved Out of their Plan's Service Area:

For any beneficiary who recently moved out of their current plan's service area, they are eligible for a 2 month SEP to enroll into a new plan within their new service area. This SEP begins either the date of their permanent move or the date they first notify their plan of the move, whichever comes last.

  • Clients who are eligible for other, less-common SEPs:

Certain individuals can qualify for a number of other SEP types, we will go into the details about these below.


Part D SEPs

Part D eligible clients are unique in that there are multiple ways in which an individual can become eligible for a SEP. Some of these ways include:

  • Individuals who lose their employer Part D plan- They then have a 2 month SEP to enroll into a new Part D plan, beginning the day they lose said coverage.

  • Those who become eligible via Low Income Subsidy (LIS) or Extra Help- When this is the case, clients have an ongoing SEP to change MAPD or Part D plans, on a monthly basis, for as long as they qualify for the Extra Help. If they do lose their Extra Help, they then have only 2 months of SEP to change MAPD or Part D plans following their notification of the subsidy loss.


Unique SEPs

Below are some of the less common SEP qualifying scenarios:


  • Medicare terminates contract with client's MA or Part D plan- Whether because of misconduct by the MA carrier or other reasons, this circumstance creates a SEP for the individual, that gives them one month prior to and two months following the termination of their MA plan to sign up for a new plan.

  • A client is living in an area with a 5-star MA or Part D Plan- 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.


SEPs Following AEP

Finally, here are some SEP examples that occur following the yearly AEP:


  • For any MA or Part D plans terminating on December 31, a SEP extending from December 8 of that year through the end of the next February is provided for the beneficiary to enroll into a different MA or Part D plan or return to Original Medicare. Any plan changes during this time period take effect the first day of the following month.

  • The other SEP that occurs after AEP is Open Enrollment Period (OEP). This is a time from January 1 through March 31 in which beneficiaries who disenroll from a MA plan can enroll into a new Part D plan.


Staying active in between AEP can net you substantial business and affords you the opportunity to add clients who have needs that extend beyond the typical Annual Enrollment Period. SEP is an opportunity that Agents, looking to grow their business, should take advantage of, as it provides beneficiaries with much needed coverage and the agent the opportunity to maximize their business's potential.

Take advantage of this SEP and RSVP for one of our upcoming Medicare plan trainings on Producer Academy!

If you are not an agent partner with Keystone Advisors, call us at 346-233-1992 to speak with one of our agent managers.

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