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A Medicare Open Enrollment Primer for Insurance Agents

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Medicare is a complex system with numerous finite rules and regulations governing its operation. One of the most unique aspects of Medicare is the ability for eligible beneficiaries to select a health plan through private insurance. These health plans, known as Medicare Advantage plans or Medicare Part C, offer participants wider benefits and options than original Medicare with the flexibility to select the plan that best fits their health condition and budget.

Each year, Medicare Advantage plans are offered to these beneficiaries during open enrollment from Jan. 1 until March 31. During this time, Medicare beneficiaries are given the opportunity to make one change to their plan. Whether it’s a change from one Medicare Advantage plan to another or a change from original Medicare to a Medicare Advantage plan with a prescription drug plan or vice versa, this is the only opportunity they will have during the year to select what type of coverage they receive.

Additionally, anyone with a prescription drug plan (standalone prescription drug plan or Medicare Advantage plan with a prescription drug plan) that is effective on Jan. 1, 2009, is eligible for open enrollment.

For agents who offer Medicare Advantage plans, it is important to reach out to the community during this time and identify potentially eligible individuals and provide them with a comprehensive overview of what types of plans are available to them during this brief enrollment period. The successful agent will employ the right mix of marketing, outreach, sales training, and experience to not only identify those eligible for a Medicare Advantage plan, but to also help them find the best plan. In addition, grassroots community outreach is becoming more important each year. Participating in community outreach, community organizations, and senior interest groups helps build your community network and serves as a tool for connections year round.

There is a dichotomous philosophy when it comes to attracting prospective members throughout the year. Many companies focus on the annual election period just before January, while others pour their marketing efforts into open enrollment. Both are potentially lucrative; however, open enrollment affords agents more time to review options with prospective members and help them select the best plan.

The Centers for Medicare and Medicaid Services recently announced additional marketing guidelines for the open enrollment period. These rules are intended to protect seniors and enable them to make the most informed decisions on their Part C Medicare Advantage coverage. Sales agents in all capacities should not only review these new regulations but should be extraordinarily familiar with each guideline, as penalties for violating these rules are severe to both the writing agent and the health plan. Click here for a full listing of all marketing guidelines and frequently asked questions about these rules.

Gary Adkins is the vice president of sales for Windsor Medicare Extra. He can be reached at 615-782-7838 or [email protected].

Open Enrollment Review

  • Open enrollment is held from Jan. 1 to March 31
  • Agents should seek out companies with a healthy portfolio of products, including special needs plans for chronic conditions
  • Success will come from the right mix of marketing, outreach, sales training, and experience
  • Always find the right plan for each prospective member
  • Participate in community outreach – be active in the community you serve
  • Know the rules and regulations inside and out


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