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Enrollment Changes Hitting Medicare Advantage

Enrollment Changes Hitting Medicare Advantage

With welcome season in October upon us, Medicare Advantage (MA) health plans are preparing for two major enrollment-related changes. One offers great opportunities for plans to increase enrollment while another may bring limitations.

As part of the 21st Century Cures Act, the Medicare Advantage Disenrollment Period (MADP) (January 1 to February 14 of each year) was discontinued. This period allowed beneficiaries who had enrolled during the Annual Election Period (AEP) from October 15 to December 7 of the prior year to disenroll from that MA plan and re-enroll in traditional Medicare fee-for-service (FFS). The MADP is being replaced with a new Medicare Advantage Open Enrollment Period (MA OEP). Beneficiaries who enroll in an MA plan during AEP can now switch to another MA plan or disenroll and enter Medicare FFS. This period goes from January 1 through March 31.

The second change impacts certain dual eligibles who now effectively have a Special Enrollment Period (SEP) throughout the first nine months of the calendar year (they are already covered by the AEP). These duals are able to enroll in, disenroll from, or switch MA plans as often as monthly. A new rule change effective January 1 will limit these duals from making changes to once per calendar quarter. In addition, those “at risk” or “potentially at risk” for misuse or abuse of a frequently abused drug will not be able to take advantage of this change.

The effect of the first change is that plans get to capture additional membership for 90 extra days. At the same time, they also risk losing enrollments through greater churn. This is a risky change for some plans while exciting news for those that are high-rated plans (members tend to flock to them now) and those with stellar sales crews. The second change broadly limits opportunities for all plans but does provide for less churn overall.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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