It may seem early to start preparing for the 2024 Annual Enrollment Period (AEP), but after the Memorial Day holiday, the season comes quickly. Now is the time to prepare by—identifying your resource needs, updating your training programs, and planning for system changes. Don’t wait until July to start these activities; begin now to ensure your systems are properly configured and tested, your resources are planned and engaged, and training is set to begin in early August.
Resource Planning & Training
Year-over-year enrollments into Medicare Advantage (MA) and/or Prescription Drug Plans (PDP) continue to rise. According to recent data, Medicare Advantage now provides Medicare coverage for more than half of all eligible beneficiaries of Part A and Part B. Industry competition is high—all plan sponsors should analyze their expected or targeted growth against their current membership support team to determine if temporary resources are needed.
The best way to estimate your 2024 staffing needs is to compare your prior year’s volume of enrollments and the number of resources to your 2024 enrollment projections and current staffing. Is your staff on hand sufficient, or will you be understaffed if you meet projections? Are you covered if your actual enrollments exceed projections? AEP is not the time for lean staffing plans and operations. The first few months of a member’s experience are critical. Under-supporting a member or incorrectly processing their enrollment could result in member complaints and/or rapid disenrollments from your plan.
Identifying your resource needs is the first step. The next critical step is updating your training program and materials to ensure your current and new resources are properly trained and equipped to handle this next AEP. Has your training program been updated to align with the current MA and PDP Guidance? Do you have a dedicated lead trainer or vendor to develop and oversee your AEP Preparedness training? Prioritizing and investing in this training will save you time and money in the long run and heighten your member’s experience.
Timely System Configuration Changes
System Configuration changes are time-consuming and costly. Analyzing your systems and their readiness is fundamental to a successful AEP season.
Key system changes, configuration, and processes to consider:
- Transaction Reply Report (TRR) Processing – Even for small plan sponsors, it’s difficult to keep up with numerous Transaction Reply Codes (TRCs) that come in from CMS without a tech-enabled tool or system. Configuring your chosen tool/system to streamline your inbound TRCs, will help you process a member’s enrollment and their special statuses accurately and timely.
- Expect an increase in LIS Changes from the expansion of Low-Income Subsidies (LIS) as announced in the 2024 HHS-CMS Final Rule. CMS will expand eligibility for the full low-income subsidy (LIS) benefit to individuals with incomes up to 150% of the federal poverty level who also meet LIS eligibility criteria. This change will go into effect on January 1, 2024, and will provide the full low-income subsidy to beneficiaries who currently qualify for a partial subsidy. It’s expected to impact approximately 300k beneficiaries.
- Plan Updates – Notify your IT area or vendor of impending plan changes now. The sooner they are aware of adding/removing plans or updating your branding, the sooner they can budget and plan for those system changes. Waiting to announce possible changes after your bid is processed often requires an expedited change request costing plan sponsors more.
- CMS’ End-of-Year 2023 Enrollment and Payment Systems Processing Information Memo – CMS issues this HPMS memo between Mid-August and Mid-September. Plan sponsors must understand how the timeline and information contained in this memo impact their system updates and processing. Key topics outlined in this memo include:
- Medicare Advantage & Prescription Drug (MARx) System Transaction Processing
- Rollover and Terminating Plan MARx Transaction Processing
- Plan Reports and System User Interface (UI) Availability
- Part C & D Reporting – Is your system properly configured for the latest Part C & D Reporting Requirements for Enrollment and Disenrollment? Timely submissions are required, and with other year-end activities requiring your attention, configuring your systems now to effectively track and collect enrollment/disenrollment data, could save your organization significant time.
We’re Here to Help – CODY’s team of industry experts, veteran staff, and MA-PDP-centric systems can support your AEP Preparedness activities by:
- Performing current state assessments on people, processes, and systems
- Developing training programs and conducting training
- Offering out-of-the-box modules to support membership operations
- Temporary staffing and consulting for membership services
To learn more, contact us today for a consultation.
About us: Founded in 2006, CODY® is an Industry leader in Governance, Risk, and Compliance (GRC) Solutions designed exclusively for health plans. We enable over 70 government-funded, commercial, and ACA health plans across 50 states and Puerto Rico to mitigate compliance risk, maximize efficiencies, and improve outcomes. Our Enterprise technology and innovative solutions reduce administrative costs, increase accuracy, ensure regulatory compliance, and provide a better experience for plan members and providers. www.codyconsulting.com