Tips for Staying Compliant during the SEP

Written by Jessica Adkins

January 8, 2018

Q. Do you have tips to help stay complaint during the SEP?

As an independent insurance broker in the Medicare market, understanding the opportunities available to Medicare beneficiaries during the SEP can significantly increase your year-round selling opportunities. The Special Enrollment Period, or the SEP, allows Medicare beneficiaries to make changes to their Medicare Advantage (Part C) plan or Medicare Part D Prescription Drug plan outside of the Annual Election Period (AEP.)

There are multiple SEP opportunities, and it’s a good idea to review your book of business for the following:

  • Change in address
  • Loss of current coverage
  • Chance to get other coverage
  • Plan changes its contract with Medicare
  • Dual Eligible for Medicare and Medicaid Plans
  • Extra help or Low-Income Subsidy Eligible
  • Enrolled in or lose State Pharmaceutical Assistance Program
  • Chronic Condition diagnosis

Becoming an expert on these SEP’s will increase your referrals from clients that you have been able to assist in making a plan change. While these opportunities are significant, it is also imperative to remain compliant with your marketing activities to reach these potential members. The Medicare Marketing Guidelines (MMGs) apply year-round and not specifically to the AEP.

A few critical reminders are listed below that will help avoid a sales allegation during the SEP.

  • Permission to Contact
    • Use a CMS-approved lead piece or vendor. Agent Pipeline has multiple CMS and carrier approved pieces you can customize.
  • Scope of Appointment
    • Scopes are required for every face to face appointment. You can contact your Regional Sales Director for a generic scope of appointment to use.
  • Medicare Marketing Guidelines
    • Be familiar with the rules of the road for marketing Medicare plans. You can click here to download a copy of the Medicare Marketing Guidelines.
  • Website Approval
    • All website content, and in most cases, social media content, must be approved by the insurance carriers. You can submit your website to our Compliance Board for further assistance.

Become an expert in the Special Enrollment Period! Once you do, you will see the increase in new clients who qualify for Medicare plans! Be sure to avoid the typical compliance pitfalls and to establish a long-term presence in your community in assisting these members. If you have any other questions regarding staying compliant during the SEP, please submit your questions to our Compliance Board now! Email complianceboard@agentpipeline.com to learn more. If you’re in need of marketing piece approvals, or if you would like help to develop your own Compliance Program, click here now.

– Lester Conn, Regional Vice President

Lester Conn has been with Agent Pipeline for over 8 years and is currently the Regional Vice President in the California, Wisconsin, Minnesota, Missouri, Illinois, Michigan, and Ohio markets. Before working at Agent Pipeline, Lester was an agency owner specializing in life insurance products. If you would like to speak with Lester, contact him at 800-962-4693 ext. 6463.

You May Also Like…

What Insurance Agents Should Do After AEP

What Insurance Agents Should Do After AEP

With the 2022 Medicare Advantage Annual Enrollment Period coming close, it probably feels like you are getting to the end of running a marathon. Once things come to a close, it’s time for you to evaluate what went well this AEP and what could use some fine-tuning.

read more