Photo of Medicare Advantage Annual Election Period enrollment form.

After last year’s Annual Election Period, Medicare Advantage now accounts for more than 50 percent of the total Medicare population—30.19 million of the 59.2 million people with both Medicare Part A and Part B enrolled in a private plan.

As Medicare Advantage grows more popular with enrollees while remaining lucrative for insurers, Medicare Advantage’s percentage of the Medicare populations should only increase.

This increase in popularity brings an increase in competition. For Medicare Advantage Plans and BPOs, covering the costs of care and treatment of members is no longer enough. Today’s members expect you to elevate their experience while providing value. Doable, yes. Easy, no. To pull it off, it needs to be prioritized, which begins with your Annual Election Period (AEP) preparation.

With the AEP rapidly approaching (running October 15 to December 7), here are six items Medicare Advantage Plans and BPOs must ensure are complete within the CMS regulatory timeframes.

  1. CMS Readiness Checklist – Released annually, the readiness checklist reminds Medicare Advantage plans of critical part C&D readiness items prior to AEP and coverage beginning January 1. Plans need to review the checklist and take the necessary steps to fulfill requirements for the upcoming contract year.
  2. Call Scripts – Annual plan benefit and regulatory changes may impact existing informational, enrollment, and telesales scripts. Plans should review all scripts, identify changes needed, and submit scripts requiring change to CMS for review and approval.
  3. Member and Provider Website and Material Updates – CMS has strict Medicare Advantage communication and CMS Marketing Guidelines, (many requiring CMS approval within a defined timeline), including requirements surrounding:
    • ID cards
    • Plan website
    • Posted materials
    • Member and provider communications
  4. System Updates – As annual benefits, premiums, and guidance change, plans need to verify internal and external systems are updated to align with the new calendar year rates and benefit offering, including but not limited to:
    • Plan premiums
    • LIS premium and co-pay levels
    • Deductible
    • Maximum out of pocket, benefit maximums and limitations.
  5. Vendor Files and Oversight – As a result of annual plan and regulatory change, plans need to work with their vendors to ensure the following meet both CMS and plan requirements for the upcoming year:
    • Member materials
    • Operating systems
    • Inbound and outbound file transfers
    • Policies and procedures
  6. Annual Policy and Procedure Review – Plan operations and regulatory changes can and often do impact existing policies and procedures. Plans should ensure the update, review, approval, and distribution process are completed by end of year.

There are many health plans offering Medicare Advantage. Competition is stiff. With the ever-changing regulations and heavy workloads within health plans, healthcare systems, and BPOs, successfully executing Medicare Advantage AEP is easier said than done.

Health care solutions providers like Garnet Care help guide organizations though AEP and deliver where gaps exist. In the process, they ensure deadlines are met; employees are supported, thereby reducing burnout; quality issues and compliance failures are addressed; and operational costs are managed and minimized. The result: an improved member experience, greater value, and a competitive advantage.

Photo of Garnet Care practice lead Courtney Seypura

Courtney Seypura is practice lead for Garnet Care. She has more than 20 years of experience in Medicare and Medicaid operations and project management. Garnet Care helps health plans, administrators, hospitals, and providers improve patient experience and program performance through system and process optimization. Courtney can be reached by email at or by phone 518-605-0216.

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