SEPs: What Your Clients Should Know


Can I Tell Enrollees That They Can Use an SEP to Switch Medicare Plans?

No. Encouraging beneficiaries to enroll in a lower-rated plan during the Medicare Annual Enrollment Period (AEP) under the pretense that they can change to a higher-rated plan at a later date is not allowed, according to CMS rules (MMG, Section 40.6.2).

If a Plan Has a Low Performing Icon (LPI), Can I Show Enrollees Only the Higher Overall Rating?

No. You can’t misrepresent the ratings for the overall plan. For example, if a Part D plan has a three-star rating, but its Part C counterpart has an LPI, you must reference the LPI in your presentation of the overall plan. You must also state that the LPI means that it received a 2.5 rating or below for the last three years.

When a plan receives an LPI due to alternating low performance on Part C and Part D ratings, the most recent low rating must be noted.

Can I Leave Out the LPI Icon in Marketing Materials?

No. The LPI icon must be included in all marketing materials that reference the plan’s star rating.

Can I Alter the Appearance of the LPI?

No. Changes are not permitted to the icon.

Where Can I Get More Medicare Marketing Guidance?

Our resource center is available 24/7 to give you the help you need with Medicare guidelines, sales advice, and more to keep your business on track. To learn more about the Excelsior team and how we can help you, contact us.

 

Sources: https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/CY2019_Medicare_Communications_and_Marketing_Guidelines.pdf | https://www.medicareinteractive.org/get-answers/overview-of-medicare-health-coverage-options/changing-medicare-health-coverage/the-five-star-rating-system-and-medicare-plan-enrollment

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References
https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/CY2019_Medicare_Communications_and_Marketing_Guidelines.pdf

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