The upcoming Annual Enrollment Period  (AEP) is between October 15 and December 7, 2020 and will be completely different from all the previous AEPs put together. The COVID-19 pandemic has brought unprecedented changes that no man or machine could have predicted.
There will be additional aspects in the AEP this time, unlike what would normally be included from the health plans. Under other circumstances, by now all tele-sales agents have been contacted and face-to-face classroom training would have been started. Key information about new plans, services areas extensions, change in plan benefit packages (PBPs), and training on social determinants of the health (SDoH) & CMS (Centers for Medicare & Medicaid Services) compliance requirements would have been shared. In parallel, the operations teams would have been performing deep-dive sessions with various disparate systems of health plans and reviewing the learning from the previous year’s AEP.
These activities may still happen with this AEP, but they would be done virtually and remotely. While social distancing is critical in preventing COVID-19, this distancing is also posing critical challenges for health plans.
Member engagement – As we know, since agents/brokers are not going to have kitchen table meetings with beneficiaries, most of the discussion would happen over the phone or video calls.
Operations team – Health plans that have partially automated processes and depend on local processes and paper-based checks and balances will have challenges in performing end-to-end enrollment intake to CMS submission scenarios
The convenience provided by the ‘AEP command center’ enabling team members to work closely will be missed
Surge in inbound calls – Since seniors are not going to have kitchen table meeting with agents, they will call the health plans. Health plans need to have adequate tele sales agents to handle this surge.
New CMS changes – Interoperability and Patient Access final rule (CMS-9115-F)
Retaining existing customers through Social Determinant of Health (SDoH)
The core of AEP preparedness will start from creating “AEP Command center”, which monitors all the 4 components – People, Process, Technology & Infrastructure. An impact analysis of Covid-19 on each of these components would enable Health plans to be well prepared for the upcoming AEP. Wipro hosted a webinar and discussed these 4 core components as part of “Medicare AEP Growth and changes in the wake of COVID-19: How to overcome the Challenges!”.
Medicare Open Enrolment is also known as AEP.
Every year, Medicare’s open enrollment period is October 15 - December 7.
Medicare health and drug plans can make changes each year—things like cost, coverage, and what providers and pharmacies are in their networks. October 15 to December 7 is when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs
Santosh Gundurao Gurlahosur
With the expertise in Healthcare Information Technology, Santosh brings in a blend of domain, technology, delivery & program management experience. He has managed and grown large customers and is focused on building products, end-to-end customer management and nurturing robust & efficient teams to manage complex Healthcare & Medicare advantage products & services. Santosh is also AHIP certified. He can be reached at Santosh.firstname.lastname@example.org.