Medicare Advantage Open Enrollment Period

What You Need to Know

The Medicare Advantage Open Enrollment Period (MA-OEP) runs from January 1 through March 31 each year. This period allows beneficiaries who are already enrolled in a Medicare Advantage plan to make a one-time change to their coverage. During MA-OEP, a patient can switch to a different Medicare Advantage plan or drop their current plan and return to traditional Medicare (Parts A and B). If they choose to return to traditional Medicare, they can also enroll in a standalone Part D prescription drug plan. This period does not allow individuals to switch from traditional Medicare to Medicare Advantage, and only one change is allowed during this timeframe. Any new coverage begins on the first day of the month following the plan’s receipt of the request.

What This Means for You

MA-OEP is a critical time to pay close attention to coverage changes. Patients may switch plans or revert to traditional Medicare, which can significantly impact authorization requirements, billing processes, and network participation. To help prevent denials and delays in care, educate your staff about these potential implications and always reverify eligibility before delivery. If you notice that a patient’s plan has changed, carefully review each of the following:

• Whether you are a contracted provider and in-network with the new plan.
• If the device you are delivering requires prior authorization from the new plan.
• If different coverage requirements must be met and documented for the device you are providing.
• If the patient's financial responsibility (i.e., deductible and/or co-insurance) has changed.

Communication with your patients during this period is vital. You should let them know about any significant changes to their coverage and/or financial responsibility as soon as possible. If you have a patient who continues to receive denials from their current Medicare Advantage plan, you may want to inform them about the opportunity to switch to a different plan with better coverage. Furthermore, if you learn that a patient is considering a plan change, encourage them to confirm coverage for their DMEPOS needs before making the switch.

You can find out more about Medicare enrollment periods, including the MA-OEP, here.