Open Enrollment Period (OEP)—How to Retain Members

You have worked hard to gain and retain members—don’t let the Medicare Advantage Open Enrollment Period (MA OEP) be a time to lose them!

The MA OEP runs from January 1 – March 31. During the MA OEP, Medicare Advantage plan members may switch to another MA plan or disenroll from their MA plan, return to Original Medicare and add a Medicare Part D (prescription drug) plan. Individuals may make only one election during the MA OEP. Members enrolled in an MA-only plan may add or drop separate Part D coverage during the MA OEP. Members enrolled in either MA-PD or MOpen Enrollment PeriodA-only plans can switch to MA-PD, MA-only, or Original Medicare (with or without a stand-alone Part D plan).

Newly eligible Medicare beneficiaries who are enrolled in an MA plan during their Initial Coverage Election Period (ICEP) also have an OEP from the month of entitlement to Part A and Part B to the last day of the third month of entitlement.

An MA OEP election’s effective date is the first of the month after receipt of the enrollment request.

The MA OEP is not available for an individual enrolled in Original Medicare to join a MA plan. It also does not allow for Part D changes for individuals with Original Medicare, including those enrolled in stand-alone Part D plans. The MA OEP is not available for Medicare Savings Accounts or other Medicare health plan types (such as cost plans or PACE).

The rate for switching during Open Enrollment Period (OEP) or rapid disenrollment ranges from 5-30%. That could negate any gains in membership during the Annual Election Period (AEP). Review your access points and barriers to information and services from a member’s perspective.

Steps to Open Enrollment Period (OEP) Success:

Customer Service – This is not just your call center. Think beyond the speed to answer the phone or hours of operation.

  • Ensure that your customer service staff has the necessary access to systems to provide “one-call resolution” for member requests.
  • Provide a member portal, but don’t require it. Not everyone is comfortable using electronic means to communicate health information.
  • Review member communications for each individual member. Too many letters and notices are burdensome, and the content may not be relevant for the specific member.
  • Coordinate messages across all media; have the flyer, the letter, and the posters contain consistent messaging in common areas.
  • Offer case manager access for members with co-morbidities. A member’s health makes their interactions with the plan more personal. Remove unnecessary barriers and steps before reaching someone who can assist the member immediately.
  • Communicate in plain language. The MA world contains many technical terms. Look for opportunities to rephrase things in a way that is easily understood.

Provider Network

  • Make sure your network matches the benefits. CMS tests network adequacy for specific specialties, but you should also ensure your members can access all benefits offered.
  • Communicate with your providers on plan benefits and optional services. Members seek information from their providers as well as from the health plan. You want to offer a positive experience for members, regardless of where or how they receive information.

Review your Data

  • Analyze the reason(s) why members are contacting you. Look for patterns and common issues. How can you explain benefits or plan rules more clearly?
  • Delve into the root cause of grievances and appeals. Why are your members dissatisfied? Are they regularly appealing certain services? What can be done to remove these pain points?
  • Review the Disenrollment Reasons Survey results. CMS sends out these surveys to a random sample of members who voluntarily disenrolled from each contract. The results of the survey, are included in the Display Measures.

We’re here to help

Cody Consulting can analyze your processes and data to provide suggestions for improvement. An objective review done with a member lens can be the difference between keeping and losing members. To learn more, contact us today for a consultation.

 

About us: CODY® works with over 70 government-funded, commercial, and ACA health plans across 50 states and Puerto Rico. We help align internal operations with CMS guidelines to improve regulatory compliance, maximize performance, and streamline member/provider communications across the enterprise. CodySoft® and Synchronicity™, our proprietary suites of software, are designed specifically for health plans. www.codyconsulting.com