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Pre-AEP Information

CareFree is here to help with your final preparations for AEP. Before you begin marketing and selling, review this Top 10 list to ensure your sales activities are compliant. Click the plus sign after each topic to learn more.

1. Agents Must be Fully Contracted and Certified per State Law

  • Complete AHIP and current carrier certifications. Check your status by logging into or reaching out to carriers directly. Remember, you must re-certify to continue receiving commissions.
  • Continue to market and sell 2019 plans to age-ins or for special enrollment situations for 9/1, 10/1, 11/1, 12/1 effective dates.
  • Do not schedule appointments for 2020 sales prior to 10/1 – it’s considered marketing and a CMS violation.

2. Update Sales Kits with 2020 Star Rating Information

  • CMS generally releases new Star Ratings in mid-October and must be replaced within 21 days of being issued. Remove all 2019 Star Rating information from sales kits and replace with 2020 Star Rating information. Get the new sheets from the carrier.

3. Don’t Market Before 10/1

  • Do not send postcards or other marketing materials for 2020 plans or sales to your book of business, or to anyone who’s completed a 2020 Consent-to-Contact form for this AEP until after 10/1. This includes advertising 2020 marketing and sales events scheduled in early October.
  • Review plans in your market to add carriers with a strong value proposition. You can request additional carriers on CareFree’s website or by calling us at (888) 549-4800. Attend carrier product trainings to fully understand products.

4. Marketing from 10/1 to 10/15

  • Present 2020 plans to beneficiaries in this time period, but do not solicit or request or accept applications.
  • Don’t turn in applications before 10/15 that are signed by clients or agent and dated prior to 10/15. Collect applications after 10/15 from beneficiaries you’ve met with or call to remind them. Turn in paper Scope of Appointment forms with applications.

5. Submit ALL Events and Event Updates to Carriers

  • Report all formal and informal sales seminars and event cancellations/revisions to all carriers you wish to represent at each event according to their policies.
  • You must also check with the carrier for their process for reporting and holding educational events.
  • General event guidance can be found on CareFree’s website.

6. Submitting Applications in AEP

  • As a rule, turn in completed applications on the day they are completed, or within 24 hours of taking the application.
  • Follow each carrier’s rules for application submission. Rules can be found on the carrier’s broker portal.
  • Consider using carrier electronic enrollment tools to reduce errors that will pend or deny applications. Instructions can be found on the carrier’s broker portal.
  • Paper applications can be faxed to carriers or CareFree. Check with the carrier to see if a signed Scope of Appointment form must be attached to paper applications (when applicable).

7. Unsolicited Direct Contact / Consent-to-Contact / SOA

  • It’s a CMS violation to market through unsolicited direct contact, referred to as “cold calling,” and includes going door-to-door.
  • A signed Consent-to-Contact form must be obtained before contacting beneficiaries by phone.
  • Be sure to secure and document an SOA prior to meeting with potential enrollees when an individual or personal one-on-one appointment meeting falls outside of a formal or informal marketing and sales event.
  • SOA documentation can be: 1) beneficiary-signed, hard copy; 2) telephonic recording, or 3) electronically signed; check with carrier for their process.
  • Remember, all Consent-to-Contact and SOA forms must be maintained for at least 10 years according to CMS guidelines by either the agent or carrier.

8. Ways to Avoid Receiving Member Complaints

  • Explain thoroughly the plan type being sold and how care will be received, e.g., if a client switches from having Original Medicare with a PDP to an MAPD, they’ll now use a physician network; copays could be different.
  • Do a comparison/benefit analysis so your client knows the differences between their old plan vs. the new plan, i.e., benefits, physician network, copays, cost sharing.
  • Always confirm the client’s physicians/specialists are in network and their medications are on the formulary.
  • Be clear when explaining any included dental benefit. Some plans MAY require a provider network; some MAY offer a reimbursement benefit (member pays out-of-pocket for services, then requests reimbursement), etc.

View this simple video on avoiding allegations from the CareFree website.

9. Customer Service

One of the best ways to keep new clients is to stay in touch. Call new members to ensure:

  • They’ve received their plan information and ID Card.
  • They’ve set an appointment with their PCP.
  • They know how to take advantage of the extra benefits in their plan through mail-order pharmacies, over-the-counter supplies, and/or transportation.

10. Preparing for OEP

  • Be available to beneficiaries during the Medicare Open Enrollment Period (1/1 - 3/31).
  • During OEP, any beneficiary with any type of MA plan can make one change to any plan combination they’d like: a different MAPD, an MA, or Original Medicare with a PDP (see table below).
  • Agents and brokers cannot market during this Election Period, but they may conduct customer service calls to their own customers to make sure they are satisfied with their current plan.

If for some reason your client is not pleased with their 2020 plan selection, agents and brokers may use the OEP to make the changes below once between 1/1 and 3/31.

Currently enrolled for 1/1/2020 in: CAN make this change from 1/1/2020 - 3/31/2020:
Original Medicare CANNOT USE OEP*
MA Only Another MA Only, MAPD, Original Medicare with or without a PDP
MAPD Another MAPD plan, An MA-Only plan, Original Medicare with or without a PDP

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