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Be aware of these important, but often missed SEP opportunities

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I took a call a few weeks ago from an affiliated agent asking me when his prospective client would be able to switch from a Chronic Illness Special Needs Plan (C-SNP) HMO he no longer favored to a MAPD HMO he was eligible for, even with his illness. It turns out the agent called me while he was in the appointment.

While still on the line with me, the agent began to tell his client he would probably have to wait until the next Annual Enrollment Period to change plans. I politely interrupted, asking if the client had some other special election period option (SEP). The agent said, “No, he makes too much income. The only help he gets is Low Income Subsidy (LIS) Extra Help for medications.”

Get familiar with CMS’ most common Special Election Periods to take advantage of more selling opportunities. Clients will appreciate the special attention you’ve given to their unique health situations.

SEPs are where most agents turn a blind eye.

It is estimated that, depending on the state, 23 to 28 percent of Medicare beneficiaries are eligible for some sort of SEP, which means they may change plans at any time or specifically during the lock-in period of December 8 – October 14. SEPs thus constitute a huge block of potential year-round business outside AEP.

Back to the phone call: I reminded the agent that the LIS prescription help qualifies the client to complete an enrollment form right then and there, using the SEP provided to LIS beneficiaries.

The agent secured the sale and earned a grateful client by taking advantage of the SEP.

Take some time to become familiar with SEPs. There are over 40 time-sensitive or year-round SEP categories when counting Medicare Advantage and PDP situations, all to be interpreted as chances for you to gain more trusted clients. Here are a few of the more common examples:

  • Beneficiary moves out of current service area
  • Low Income Subsidy prescription Extra Help or state prescription assistance program and Loss of LIS Subsidy (Yes, it does happen!)
  • Medicare Advantage Disenrollment Period (MADP) for PDP
  • Institutionalized (My favorite one. Includes moving into or out of a facility — additional rules apply!)

Even if you’re in an appointment when a question pops up in your mind, our affiliated agents can feel free to call RB Insurance at

(800) 997 3107. Ask for me, Tom O’Neil.