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Agent Guide to the Insurance Enrollment Period

Insurance agent guide to insurance enrollment period in 2020 Focused African man sitting at desk wear headset watching webinar video course gain new knowledge use on-line application website. Manager talk to client provide professional help and support concept

Fall is fast approaching, which means health insurance agents are hard at work preparing for the ACA Open Enrollment Period (OEP) and the Medicare Open Enrollment Period (also known as “AEP” or the “Annual Election Period”).

A smooth experience often starts with having the right resources, so we’ve developed this agent guide to the insurance enrollment.

This guide will provide insight on what insurance agents need to know for the upcoming OEP and AEP, plus tips and insurance agent technologies that can help you save time, avoid mistakes and sell more.

What’s In This Agent Guide?

What is the ACA Open Enrollment Period?

When is Obamacare Open Enrollment in States that Extend OEP?

What Information Do Customers and Prospects Need for OEP?

What Can Customers and Prospects Do During Open Enrollment?

What If Prospects Don’t Have Existing Coverage During OEP?

What is the Medicare Open Enrollment Period?

What Changes Can Be Made During the Medicare Open Enrollment Period?

Medicare Advantage Plan Updates Insurance Agents Need to Know

7 Insurance Agent Tips to Prepare for Obamacare Open Enrollment 

9 Insurance Agent Tips to Prepare for the Medicare Annual Enrollment Period

Insurance Technology Resources for Agents

What is the ACA Open Enrollment Period?

The Affordable Care Act, also called the ACA or Obamacare, provides an annual Open 

Enrollment Period where individuals and families can sign up for health insurance without being denied coverage based on health status or preexisting condition.

Most states allow open enrollments from November 1 to December 15 each year. This date usually applies if enrollments are done via the federal Health Insurance Marketplace – also called the exchange – at HealthCare.gov. 

Some states operate their own exchanges and have longer health insurance enrollment dates. 

When is Obamacare Open Enrollment in States That Extend OEP?

While all states begin OEP on November 1, state-run exchanges can choose to extend enrollments beyond December 15. Here’s a breakdown:

  • California, Colorado and Washington, DC have permanently extended OEP as follows:
    • California: November 1, 2020 to January 31, 2021
    • Colorado: November 1, 2020 to January 15, 2021
    • Washington, DC: November 1, 2020 to January 31, 2021
  • The following states have extended the 2021 open enrollment period as follows:
    • Minnesota: November 1, 2020 to December 22, 2020
    • Nevada and Pennsylvania: November 1, 2020 to January 15, 2021
    • New Jersey and New York: November 1, 2020 to January 31, 2021

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Tip: Healthcare open enrollment dates should be on every ACA agent’s checklist, especially for those who sell in multiple states. OEP dates can change if a state operates its own exchange or switches from the federal Marketplace to a state-run exchange for the next plan year. 

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What Information Do Customers and Prospects Need for OEP?

A successful insurance enrollment period can depend on how well you prepare your customers and prospects. And that includes educating them on the following information needed when choosing Marketplace coverage:

  • Name, social security number and birthday of all enrollees. And all applicants must meet these eligibility rules: Live in the U.S., be a citizen or legal immigrant and not incarcerated or eligible for Medicare.
  • Household size and documents to prove income (paystubs, most recent tax return, W2s, unemployment benefits letter, etc) to check subsidy eligibility.
  • Coverage information for any health insurance offered by an employer.
  • A list of medications each applicant takes to see which plans cover those drugs.
  • Names and zip codes of all current doctors to verify whether they’re a part of the prospective plan’s network. 

What Can Customers and Prospects Do During Open Enrollment?

Customers and prospects can take these actions during the Obamacare open enrollment:

  1. Enroll in a new health plan. For individuals who sign up for health insurance coverage by December 15, coverage will begin January 1 of the following year. Those who live in a state where enrollment extends past December 15 and choose to sign up after that date, will have coverage effective February 1 or March 1 of the following year. 
  1. Make changes to an existing plan. Customers can make changes such as add/remove a spouse or dependent or change their address. Qualifying life events trigger a Special Enrollment Period (SEP), which allows customers to change their coverage at any time. If a qualifying event happens during OEP,  customers can use their SEP to change plans and could get coverage effective December 1. However, the plan would still renew on January 1, which could result in changes to benefits and costs.
  1. Allow their existing plan to renew. Individuals who are satisfied with their Obamacare coverage don’t have to make any changes during OEP. ACA plans sold through the Marketplace generally renew automatically with benefits effective January 1. But since benefits and prices can change each year, you should reach out to clients about reviewing their coverage.

What If Prospects Don’t Have Existing Coverage During The Open Enrollment Period?

If an uninsured prospect enrolls in an ACA plan November 1, for instance, the plan won’t take effect until January 1 – leaving him or her without coverage for 2 months. Obamacare agents have an opportunity to sell short-term health insurance to such individuals facing a gap in coverage.

Short-term medical, also called STM plans, may offer coverage for as little as 30 days depending on the state. Most states sell short-term policies, but California, Massachusetts, New Jersey and New York do not sell these plans. 

 Insurance agents should keep these 4 key points in mind before selling short-term coverage: 

  • Plans are not ACA-compliant and don’t have to offer all essential health benefits.
  • Policies don’t typically cover preexisting conditions. 
  • Applicants usually need to answer health questions (medical underwriting) to qualify.
  • States that sell plans may have specific coverage terms, so be aware of policy limitations and exclusions.

What is the Medicare Open Enrollment Period?

The Medicare Open Enrollment Period – often known as the Medicare Annual Election Period (or “AEP”) – runs from October 15 to December 7 each year.

This specific enrollment period gives Medicare-eligible beneficiaries the ability to make changes to their Medicare coverage. And those changes will take effect on January 1 of the following plan year.

But if customers are satisfied with their medical coverage, they don’t have to take any action during AEP. Plan details can change annually, so be sure to encourage your customers and prospects to review their Medicare coverage each year. 

Insurance agent guide to the 2021 insurance enrollment period Happy mature couple talking to their real estate agent while going through paperwork on a meeting in the office.

What Changes Can Be Made During the Medicare Open Enrollment Period?

If your customers or prospects want to change their Medicare insurance coverage, here are 6 actions they can take during AEP.

  1. Change from Original Medicare to a Medicare Advantage plan.
  2. Change from one Medicare Advantage plan to another.
  3. Disenroll from one Medicare Advantage plan and go back to Original Medicare.
  4. Change from one prescription drug plan (Medicare Part D) to another.
  5. Enroll in a prescription drug plan.
  6. Cancel prescription drug plan coverage.

Also worth noting: Medicare beneficiaries cannot use the Medicare open enrollment period to enroll in Medicare Part A or Part B for the first time. 

Medicare Advantage Plan Updates Insurance Agents Need to Know 

Medicare Advantage plans, otherwise known as “Medicare Part C” or “MA Plans,” bundle Original Medicare (Parts A and B) services into one plan. These plans could be an appealing option for many customers and prospects because they may include extra Medicare benefits like prescription drug coverage, rides to medical appointments and home-delivered meals.

And since the Medicare Open Enrollment Period directly impacts Medicare Advantage plan choices in many instances, it’s important for Medicare agents to understand recent or upcoming plan changes for 2021.

For example, the coronavirus pandemic sparked several Medicare changes and enhancements to certain plans to include benefits such as telemedicine and COVID-19 testing.

Changes to 2021 Medicare Coverage for People With Kidney Failure

One big change to the 2021 plan year is that people with End Stage Renal Disease (ESRD), also known as kidney failure, will now have the option to enroll in a Medicare Advantage plan. The Centers for Medicare & Medicaid Services (CMS) estimates that more than 80,000 people living with ESRD will enroll in a Medicare Advantage plan by 2026 – a significant increase of 63%.

Medicare Advantage plans may provide ESRD patients with better coverage compared to Original Medicare. As an example, many Medicare Advantage plans include access to coordinated care for your customers.

7 Insurance Agent Tips to Prepare for Obamacare Open Enrollment 

Do you want to reach more prospects and customers during OEP? This agent checklist to the insurance enrollment period can help you get a head start:

  1. Register with HealthCare.gov. Insurance agents who want to sell health and dental plans through HealthCare.gov must complete registration and training to become a federally-facilitated Marketplace (FFM) agent or broker.

    Registrations for the new plan year typically open around July/August, and training is required each year. Becoming an FFM agent or broker gives you access to new clients because prospects can find your business via HealthCare.gov’s “Find Local Help” search tool. 
  1. Know which insurance carriers are entering your market. Carriers may decide to enter or return to a market by offering plans on the federal exchange and/or off the exchange for the upcoming ACA open enrollment. Insurance carriers you’re contracted with should send you announcements around July or August. You can also learn about new carriers entering your market through online publications from local news outlets. 
  1. Prepare your portfolio. Knowing which insurance carriers will enter your market can guide your decision on which new carriers to contract with. You should also review your current carriers’ product offerings to enhance your portfolio with any short-term medical plans and/or supplemental health plans like dental, vision and hospital indemnity
  1. Start marketing early. July or August may be an ideal time to start marketing for the new insurance enrollment season. It’s recommended to start engaging prospects and customers as soon as you’re contracted with the carriers you want, and plan details for the 2021 plan year are available. There is no specific date in which you can start marketing 2021 plans. 
  1. Assess the income-level of your area. If you do business in a low- to moderate-income area, your customers and prospects may qualify for premium tax credits (subsidies) and/or cost-sharing reductions on Marketplace plans. You can help consumers determine if they qualify and apply for coverage if you’re an authorized agent or broker on HealthCare.gov. This service doesn’t cost customers anything, and you still get full commission even if they qualify for subsidies.

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Pro hack: One way to estimate your area’s income level is to look at the average home prices. You could target zip codes with lower property values using door hanger cards or direct mailers to advertise your business as a resource.
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  1. Keep your insurance leads warm. Some prospects may not do business with you right away. But if you nurture those leads, they may be more likely to reach out to you during the healthcare open enrollment period.
  1. Engage with clients year-round. Staying in contact with clients throughout the year helps them see you as a trusted resource to continue doing business with you when OEP rolls around. It also helps create more cross-selling opportunities. Plus, clients who only have supplemental coverage may be more likely to keep you top-of-mind when it comes time to choose a major medical plan. 

9 Insurance Agent Tips to Prepare for the Medicare Open Enrollment Period

Follow this Medicare agent checklist for the insurance enrollment period to maximize your AEP sales:

  1. Get contracted and appointed. Carrier contracting usually starts around June or July for the new plan year. And the process during AEP can take between 4 to 6 weeks. Completing your carrier contracts well in advance is especially crucial if you want to sell plans for multiple carriers, which can help you reach more prospects and clients. 
  2. Keep your AHIP certification up-to-date. Most carriers require Medicare agents to complete the America’s Health Insurance Plan (AHIP) certification to sell their Medicare Advantage and Part D drug plans. The certification, which covers Medicare rules and fraud, waste and abuse, is required every year because CMS rules can change annually. You’ll need a score of 90% or better to pass.
  1. Prepare for the AHIP exam early. Exam registration starts around June/July. Carriers may offer early-bird discounts on the exam fee ($175) if you register through their portal. The final exam has 50 questions and requires 2 hours to complete, so you’ll want to prepare by taking AHIP practice tests. You only get three attempts to pass. If you fail, you may not be able to sell Medicare Advantage (Part C) or Prescription Drug (Part D) plans for that plan year. 
  1. Complete carrier certifications/product training. In addition to contracting with carriers and taking the AHIP exam, you’ll need to complete carrier-specific certifications to sell their products. Product training usually starts in August. The earlier you get through training, the more time you’ll have to focus on your prospects and clients. 
  1. Order supplies from carriers in advance. This may be an overlooked task when preparing for Medicare Open Enrollment, but it’s very important because carriers can run out of supplies. So you should stock up on supplies like:
    1. Medicare marketing materials: This includes carrier-approved flyers and postcards, AEP client letters and “request for more information” forms 
    2. Language-specific materials: You may need marketing materials in another language depending on where you do business. Carriers provide materials like flyers, letters and radio scripts in other languages such as Spanish.
    3. Medicare enrollment kits: This typically includes items such as enrollment applications, pre-enrollment checklists that contain important benefit information for customers, Medicare Advantage star ratings, and county-specific plan details 
  1. Help clients review their ANOC. Clients who are currently enrolled in a Medicare plan will receive an Annual Notice of Coverage (ANOC) that details any changes effective on January 1. ANOCs are usually sent in September. So you should contact your clients before September each year to remind them about their ANOC and that you’ll reach out to them to review their coverage.

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Pro hack: Make customers who may want to change their Medicare coverage your focus during the first few weeks of AEP marketing. You can market specific Medicare plans starting October 1.
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  1. Leverage social media. Facebook is the most popular social media platform among seniors. In fact, 46% of Americans 65 and older are Facebook users. You can post generic content about Medicare throughout the year, which can help you build a following. Plan specific details for the upcoming AEP can only be shared after October 1. 
  1. Host educational events. This can be a great way to build trust with seniors and gain referrals. You can’t discuss plan specifics or pass out marketing materials or enrollment applications at an educational event. But you can hand out business cards and set up future appointments at the end of the event. CMS requires Medicare agents to explicitly advertise the event as educational. 
  1. Stay compliant with Medicare guidelines. CMS can change its Medicare marketing guidelines annually. Failure to stay compliant affects enrollees and your commission if an enrollment application is rejected for non-compliance. Here are some things to keep in mind: 
    1. You cannot advertise the 2021 Medicare AEP or market specific plans before October 1, 2020. 
    2. You cannot take enrollment applications for a January 1 effective date prior to October 15.
    3. Remember to complete a scope of appointment (SOA) form prior to meeting with prospects and clients about Medicare Advantage or Prescription Drug plans.  

For the full CMS Marketing Guidelines, click here

Insurance Technology Resources for Agents

Increasing your productivity is vital during the insurance open enrollment period because you have a short window to reach your audience and sell plans.

Here are some technology resources ACA agents and Medicare agents should use to enhance customer engagement and close more sales:

  • Virtual meeting app. Many customers and prospects may be looking for alternatives to meeting in person due to COVID-19. So you should get acquainted with virtual meeting software like Zoom or Microsoft Teams that lets attendees participate on the web or from a mobile device.
  • Email platform to set up automated emails. As the ACA open enrollment and Medicare AEP approaches, you’ll want to engage customers and prospects at the right times. For example, you could set up emails to go out 30 to 90 days before insurance enrollment dates and again during enrollment. Because you can automate emails in advance, this gives you more time to focus on other priorities. And don’t be afraid to ask your marketing team for advice on how to automate.
  • Integrated quoting and sales management platform. Managing your sales and agent activities is easier with access to a central platform that delivers convenience and efficiency. Benefytt is a resource for agent technology solutions that lets you access carrier products and plan materials, complete quotes, view sales insights, track carrier appointments and more – all in one place in real time.

Ready to make the 2021 OEP and AEP season the best one yet? Now that you have helpful information and tips in this agent guide to the insurance enrollment period, you have a competitive advantage to grow your client base and sell more.