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Latest news and updates about the Medicare and pharmacy industries.

Reaching Patients Beyond Medicare Open Enrollment

Posted on December 14, 2020 by Amplicare Team

Last week, the Medicare Open Enrollment (OE) period came to an end, thereby closing a crucial opportunity for Medicare beneficiaries interested in making changes to their plans. If your pharmacy serves a sizable Medicare population, the seven weeks of Medicare OE can be intense with plan comparisons and patient consultations. And with 57% of beneficiaries not comparing plan options, there’s the added challenge of ensuring all your patients have the information they need to make informed decisions.  

The good news is that Medicare OE, while an important period, is not the only time of year to reach and engage with Medicare beneficiaries. In fact, there are multiple opportunities to help patients compare plans throughout the year, depending on their situations. Below, we look at a few of these options and how to take advantage of them to help your patients.

1. Medicare Advantage Open Enrollment Period

Patients enrolled in Medicare Advantage plans have some extra time at the start of the year to make adjustments to their options. Between January 1 and March 31, beneficiaries who are unsatisfied with their current benefits will be able to compare plans to find options that work better for them. However, unlike the general Medicare OE period, beneficiaries are only allowed to make one switch during the three-month period. According to the Kaiser Family Foundation, in 2020, more than a third (36%) of Medicare beneficiaries were enrolled in Medicare Advantage plans, and enrollment in these plans grew by 9% between 2019 and 2020. The popularity of these plans among patients makes this extended enrollment period key for pharmacies. When comparing Medicare Advantage plans for patients, keep in mind that there are additional considerations such as prescription drug benefits and doctor networks, so using a comprehensive software like Amplicare can be beneficial. In addition to plan comparisons that estimate all of a patient’s out-of-pocket costs (and the DIR fees for the pharmacy), our platform also provides a doctor lookup tool to help you verify a patient’s physicians are in network with a new plan.

2. Initial Enrollment Period

When a patient first becomes eligible for Medicare, they have a set time frame during which they can enroll in a new plan. This seven-month window includes the three months before they turn 65, their birth month, and three months after. According to a 2020 GoHealth study, 57% of people nearing Medicare eligibility say they are overwhelmed at the idea of finding a plan. This gives pharmacists the perfect opportunity to provide some much-needed guidance around Medicare and what plan options could mean for the patient. To help, Amplicare provides a dedicated “Newly Eligible” report that identifies patients in their Initial Enrollment Period to make it easy to reach out. Additionally, Navigate, our patient-facing online enrollment portal contains educational material on the basics of Medicare to help patients get a better understanding of what is expected. The use of Navigate’s resources can also be supplemented with phone consultations, a great option especially as patients continue to social distance. One important thing to remember when helping newly eligible patients: once they enroll in a plan, they will not be able to switch plans until the annual Medicare Open Enrollment period.

3. Special Enrollment Periods

Special enrollment periods (SEP) are special circumstances during which a beneficiary can make changes to their Medicare Part D or Medicare Advantage plans. For instance, if a patient moved to a new address that isn’t in their current plan’s service area or their plan’s contract with Medicare changes, they may be eligible to enroll in a new plan outside of the general Medicare Open Enrollment period. Counties that have experienced a FEMA-related event such as a flood or wildfire that adversely affected a patient’s ability to enroll in a plan would also qualify for a special enrollment period. It’s important to note that the guidelines around the types of changes that can be made differ for each SEP. CMS also offers patients who believe they “made the wrong plan choice because of inaccurate or misleading information” the opportunity to call 1-800-MEDICARE to explain their situation and make changes.

4. Special Enrollment Periods for Dual Eligible Beneficiaries

Dual eligible beneficiaries are patients who qualify for both Medicare and Medicaid or receive extra help through Social Security. In addition to the Medicare Open Enrollment period, these patients are able to join, switch, or drop their Medicare Part D or Medicare Advantage coverage once per quarter in the first three quarters of the year. Any plan changes during the SEP take effect the first day of the month following the change. Amplicare helps to easily identify the dual eligible patients at your pharmacy as well as those with win-win financial opportunities that benefit both the patient and the pharmacy. In these instances, patients who review their options are likely to switch to a plan which also offers them better coverage.

Medicare Open Enrollment may be over, but the opportunities to help Medicare patients don’t stop on December 7. By taking advantage of the options above, you’ll be able to increase patient retention and pharmacy profitability at multiple points throughout the year. As you develop a plan to reach your patients in the new year, Amplicare’s team of experts is always ready to help out.


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