The Annual Enrollment Period ends, and most health plan operations teams take a breath. That relief rarely lasts long. Every January 1, a second, quieter surge begins, and it catches plans off guard almost every year. This is the Medicare Advantage Open Enrollment Period, or OEP, and it runs from January 1 through March 31. Handling that window well takes more than a phone tree and good intentions — it takes Medicare OEP call center support built specifically for buyer’s remorse, confusion, and genuine plan mismatch. Ameridial has spent years supporting these calls, and the pattern holds steady year after year: plans that treat January as an afterthought lose members they didn’t need to lose.
What Is the Medicare Advantage OEP?
OEP is often confused with AEP, and that confusion costs plans real members. AEP runs from October 15 through December 7 and lets anyone shop, join, or leave a Medicare Advantage plan for the following year. OEP is narrower. It’s generally available from January 1 through March 31, and eligibility is limited to people already enrolled in a Medicare Advantage plan who now have second thoughts about that choice.
During this window, a member can switch to a different Medicare Advantage plan or return to Original Medicare with a standalone Part D plan. A Medicare Advantage enrollee can generally make one plan change during the OEP, which raises the stakes considerably — one bad experience on the deciding call can shape that member’s coverage for the rest of the year. OEP plan switching, then, isn’t a minor administrative task tucked into January. It’s the follow-through on everything your AEP marketing promised in the fall.
Why January Creates a Second Operational Surge
The scale of this problem keeps growing. Research from Engagys found that Medicare Advantage plans saw their highest member-switching rates in seven years, with 16 percent of members switching during AEP and another 7 percent switching again during OEP. Deft Research has documented a similar pattern in earlier years, when 16 percent of Medicare Advantage consumers shopped for new coverage during OEP — double the prior record of 8 percent.
Those figures represent a substantial population of members reassessing their coverage each winter, which creates real pressure on health plan service, retention, and enrollment teams. Network narrowing and benefit cuts keep adding fuel. Medicare expert Philip Moeller summed up the mood well when he described this stretch to Yahoo Finance as the “buyer’s remorse” enrollment period. That phrase belongs on every workforce planning spreadsheet a health plan owns.
What Drives OEP Plan Switching?
Listen to enough OEP calls and a handful of themes repeat constantly:
- Provider network changes — a member discovers their cardiologist or specialist quietly left the network in January.
- Prescription cost shocks — a maintenance medication jumps a tier and the copay changes overnight.
- Benefit confusion — the member doesn’t fully understand what changed between last year’s plan and this year’s.
- Prior authorization issues — a needed service or referral gets denied or delayed.
- Member service frustration — the member simply feels overwhelmed and wants someone to slow down and explain the math.
None of these members called to argue. They called because something changed and nobody explained it clearly enough beforehand. That means the agent’s first ninety seconds matter enormously. An agent who apologizes, empathizes, and resolves the underlying issue gives that member a real reason to stay. An agent who leans on a retention script without addressing the actual complaint can do the opposite — and push the member closer to the disenrollment the plan was hoping to avoid.
The Post-AEP Staffing Gap
Here’s the part most competitors leave out of their own content, probably because it’s a little uncomfortable to admit. Most licensed agents brought on for AEP get released the moment the fall rush ends. Plans then enter their second-highest-volume period of the year with their least experienced team answering the phones.
A member calling in January might be reporting a denied prior authorization, a missing specialist, or a surprising drug copay. That member deserves someone who understands the plan, not someone reading from a generic script. This staffing gap is a recurring operational blind spot in seasonal call center planning — one that shows up almost every year and is largely avoidable with the right lead time. Fixing it takes year-round capacity planning rather than a scramble each November, which is where disciplined AEP staffing volume forecasting comes in, well before January arrives.
How Medicare OEP Call Center Support Improves Member Experience
Genuine OEP member retention support starts with information, not persuasion tactics. Agents need real-time access to provider network status, formulary tiers, and benefit details specific to that member’s plan. A scripted “please don’t leave us” rarely lands on someone who has already done the math on their prescriptions.
First-Contact Resolution
First-contact resolution matters more during OEP than almost any other metric a health plan tracks. A member forced to call back twice about the same drug-coverage question has one more reason to consider switching. Every unnecessary transfer, callback, or unresolved ticket can add frustration at precisely the moment a member is reconsidering their coverage. The retention conversation needs to happen on call one, backed by accurate data — not a follow-up promise that may or may not get kept.
Licensed Support for Enrollment-Related Conversations
Not every OEP call requires a licensed agent, but the calls that involve enrollment decisions, plan comparisons, or disenrollment do. A licensed agent with plan-level depth can walk a member through referral rules, tier structures, and appeal timelines in a way general customer service training doesn’t prepare someone for. The strongest OEP model pairs licensed staff for enrollment-related conversations with well-trained, non-licensed representatives handling eligible service functions — so members reach the right level of expertise quickly, without unnecessary transfers.
Plan-Specific Knowledge
General familiarity with Medicare Advantage isn’t the same as fluency in a specific plan’s network, formulary, and benefit design. Agents who can speak precisely to a member’s actual plan — not a generic version of it — resolve more calls on the first try and build more trust in the process.
Bilingual Member Assistance
Households navigating coverage decisions in a second language face an added layer of complexity during OEP, when the details (network status, drug tiers, appeal windows) genuinely matter. Bilingual support removes a barrier that otherwise pushes members toward disenrollment simply because they couldn’t get a clear answer.
How to Staff for the Medicare OEP Surge
Treating OEP as a staffing afterthought is the single most common mistake health plans make after AEP wraps. A more disciplined approach looks like this:
- Analyze AEP call volume to understand the baseline entering January.
- Identify likely January call drivers — network changes, formulary updates, benefit shifts specific to that plan year.
- Retain a core group of trained, licensed agents past the AEP deadline instead of releasing the whole team.
- Forecast January–March demand separately from AEP forecasting, since the call drivers differ.
- Cross-train agents on both service and enrollment-related conversations where appropriate.
- Establish clear escalation pathways so complex cases reach licensed staff quickly.
- Monitor volume daily through the first weeks of January, when call patterns are least predictable.
- Scale capacity based on actual demand, not last year’s static assumptions.
OEP Call Center KPIs to Track
A few metrics tell you quickly whether your OEP support is working or quietly leaking members:
- Average Speed of Answer
- Abandonment Rate
- First-Contact Resolution
- Transfer Rate
- Average Handle Time
- Escalation Rate
- Quality Assurance Score
- Member Satisfaction
- Repeat Contact Rate
- Disenrollment and retention outcomes
Tracking these together — rather than any single number in isolation — gives operations leaders an early warning system for the weeks when it matters most.
What OEP Retention Research Shows
Engagys has documented work with a regional Medicare Advantage plan facing chronic OEP churn tied to its premium cost structure. Rather than leaning on generic retention scripts, the plan segmented its membership and rebuilt messaging around each group’s actual switching risk during the window. Paired with better-prepared call center agents, that targeted approach was associated with reduced OEP attrition compared with prior years.
The broader lesson holds beyond any single plan’s situation: segmentation combined with a prepared, knowledgeable phone team tends to outperform a one-size-fits-all retention script, regardless of how polished that script sounds on paper.
There’s a financial angle here too. According to Healthcare Business Today, provider-sponsored Medicare Advantage plans that invest more heavily in coordinated member experience report churn rates of roughly 3 to 5 percent, compared with 7 to 10 percent among national carriers. Churn definitions and measurement periods vary across organizations, so this comparison is best read as directional rather than a universal industry benchmark — but the underlying pattern is consistent with what plans see operationally: retention tends to be less expensive than replacement, and OEP is where a large share of that math gets decided.
Compliance Must Stay at the Center
OEP conversations aren’t simple retention calls. Agents need clear procedures for explaining plan benefits, handling enrollment-related questions, and escalating situations that require licensed or specialized assistance. Health plans should confirm that any outsourced team follows applicable CMS requirements, uses approved scripts, and operates within plan-specific workflows — not just during AEP, but through the full length of OEP as well.
How Ameridial Supports Medicare OEP Call Center Operations
Ameridial builds January staffing plans with the same intention most competitors reserve for October. That means licensed agents, plan-specific training, and clear accountability for outcomes. Our teams support the full enrollment lifecycle — starting with open enrollment support services in the fall and continuing through the quieter, higher-stakes conversations that follow in January, backed by dedicated post-AEP Medicare call center support.
We pair that operational depth with bilingual Medicare enrollment support for households navigating coverage in a second language, and with AEP enrollment assistance outsourcing built for compliant, high-volume seasons. OEP performance flows directly into CAHPS scores and Star Ratings, so our approach stays tied to the metrics that matter for healthcare payer services long after March 31 — across every Medicare Advantage plan we support.With the right Medicare OEP call center support in place, January changes shape. That window becomes a chance to prove your plan’s value again, rather than a countdown toward another lost member. If your team is bracing for another January scramble, talk to Ameridial — we can help build a dedicated OEP retention strategy before the surge hits. Book a consultation today.
