BIP Summer 2025

Voices

Why 2025’s OEP broke the rules — and what to learn from it When seniors don’t fully understand their plan changes by January 1, they’re far more likely to switch. By George Dippel

Ever since CMS reintroduced the Q1 MA Open Enrollment Period, Deft Research has no ticed that the OEP MA switch rate is strongly dependent on the previous AEP’s switch rate, and generally, OEP switching is 40% of what we saw in the AEP. If we see a 15% MA switch rate in the AEP, then the following OEP’s MA switch rate ought to be 40% of that, or around 6%.

we won’t see the level of Service Area Reductions and benefit cuts this October that we saw last October, which is what led to all of the disruption. There is hope that 2026 will be calmer for all stakeholders, but persistently high utilization and strained carrier finances may end up meaning that 2026 will look more like 2025. If that is the case, then what is the lesson that we can take from last AEP? As seen in Deft’s Medicare Member Onboarding Study, that lesson is that we need to help seniors understand their benefits ASAP during the AEP — don’t let them realize it after 1/1. MA seniors who learned about plan changes after 1/1 were four times more likely to end up being an OEP switcher than those who learned about plan changes before 1/1. And seniors who used an agent in the AEP were significantly more likely to find out about their plan changes before 1/1 than seniors who never worked with an agent. As agents help their clients understand their coverage chang es ASAP this fall, the more likely it is that they can take a much deserved vacation next OEP and not have to worry about their customers switching out.

have time to help them. With a record AEP switch rate of 23% in 2025, it was likely that this OEP would break the old switch record of 7%. After all, a 23% AEP MA switch rate multiplied by the 40% rule-of thumb factor yields an estimated OEP switch rate of 9%. How ever, this year’s OEP resulted in a whopping 15% MA switch rate. The 1.8 million termed members from last year put such a strain on the system that the 40% rule of thumb went out the window. Future implications Industry insiders are hopeful that the final MA rate notification that came from CMS means that George Dippel is Deft Research president and Integrity Marketing Group managing partner. His research expertise spans Medicare Advantage, MedSupp, Small Group, ACA, Uninsured, PBM and Part D.

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Agents burned the midnight oil last year helping beneficiaries, and they may need to do it again this year.

The reason OEP switching is related to AEP switching has to do with the fact that OEP switch ing is almost entirely a byproduct of AEP disruption. Whatever amount of disruption occurs to MA plans in the AEP will not all be realized or processed by December 7. Some seniors will not know what happened to their benefits, their costs or their access until they reach for their Medicare card in January. Others may know what happened, but overtaxed agents will ask them to sit tight until 1/1 when they will

22 bip magazine Summer 2025