Staying CMS-Compliant During Medicare Advantage Open Enrollment

Understanding Medicare Advantage Open Enrollment

Once the Annual Enrollment Period (AEP) ends, some clients may have second thoughts about their new Medicare Advantage (MA) plans. Whether they’re trying MA for the first time or switching plans, it’s not uncommon for them to feel uncertain about their decision.

Fortunately, Medicare Advantage beneficiaries aren’t locked into their choices. The Medicare Advantage Open Enrollment Period (MA OEP) provides an opportunity to reconsider and make changes under specific circumstances. Here’s what you need to know to guide your clients responsibly while staying within CMS guidelines.

Who Can Use the MA OEP?

The MA OEP allows certain individuals to make a one-time change to their coverage after AEP. Eligible beneficiaries include:

Open enrollment sign with doctor's stethoscope
Older couple reviewing plan details

MA OEP Enrollment Rules

During the MA OEP, beneficiaries can:

However, there are strict limits: Beneficiaries cannot switch multiple times.

Marketing During MA OEP:
What Agents Can and Cannot Do

The marketing restrictions during MA OEP differ significantly from AEP. CMS prohibits agents from knowingly addressing beneficiaries with unsolicited marketing efforts (targeting or messaging) related to the MA OEP. Here’s a breakdown:

Permitted Activities

Prohibited Activities

Effective Dates for Plan Changes

For changes made during the MA OEP, the new plan’s coverage starts on the first day of the month after the enrollment request is processed. For example, a change made on February 15 would result in new coverage beginning March 1.

Please contact Sonder Health Plans before you create any new marketing materials so they can go through the proper review and approval process

Sonder

Medicare Advantage Plans

2024 Plans
2025 Plans
Sonder Plans Service Areas