Medicare Open Enrollment: The Hidden Revenue Opportunity Most Practices Miss
Every October 15th through December 7th, a massive shift happens in healthcare that most optometry practices completely overlook: Medicare Open Enrollment.
During these eight weeks, over 65 million Medicare beneficiaries review their coverage options, compare plans, and make decisions that will affect their healthcare access for the entire following year. Many are specifically looking at their vision benefits, evaluating whether their current plan serves them well, and considering whether they need to schedule appointments before their benefits reset.
And yet, most optometry practices treat this period like any other time of year—reactive rather than proactive, hoping patients schedule themselves rather than actively helping them make informed decisions about their care.
This represents a significant missed opportunity. Medicare Open Enrollment is one of the best times to fill your schedule, serve your existing senior patient base thoughtfully, and potentially attract new Medicare patients who are actively shopping for providers.
Why Medicare Open Enrollment Matters for Your Practice
Let's start with the numbers. If even 20% of your patient base is Medicare-eligible (a conservative estimate for many practices), that means hundreds of patients are currently evaluating their healthcare benefits and making coverage decisions.
Many of these patients:
Haven't had an eye exam this year and need to use their benefits before they expire
Are considering switching to Medicare Advantage plans with enhanced vision benefits
Are confused about what their current plan covers and need guidance
Are dealing with age-related vision changes but haven't prioritized scheduling
Would appreciate a proactive, helpful outreach reminding them about their benefits
This is not about aggressive sales tactics. It's about proactive patient care and service.
When you reach out during Open Enrollment with helpful information about vision benefits and convenient scheduling options, you're providing a genuine service that patients appreciate—while simultaneously filling your schedule during what's typically a slower period heading into the holidays.
Understanding Medicare Vision Coverage
Before we discuss outreach strategies, it's essential to understand what Medicare actually covers for vision care, because many patients (and even some staff members) are confused about this.
Original Medicare (Parts A & B):
Does NOT cover routine eye exams for glasses or contacts
DOES cover medical eye exams when there's a diagnosed condition (glaucoma, diabetic retinopathy, macular degeneration, cataracts, etc.)
DOES cover one pair of glasses or contacts after cataract surgery with an intraocular lens
DOES cover certain diagnostic tests and treatments for eye diseases
Medicare Advantage (Part C):
Many plans include routine vision benefits that Original Medicare doesn't cover
Often covers annual routine eye exams
May provide an allowance for glasses or contacts ($100-300 typical range)
Benefits vary significantly by plan and carrier
Medicare Supplement (Medigap):
Generally does NOT add vision coverage
Supplements Original Medicare but doesn't expand vision benefits beyond what Medicare covers
Standalone Vision Plans:
Some beneficiaries purchase separate vision insurance to supplement Medicare
Usually covers routine exams and provides discounts or allowances for eyewear
This complexity is precisely why patients need guidance—and why your proactive outreach during Open Enrollment is valuable.
The Two Strategic Opportunities During Open Enrollment
Medicare Open Enrollment creates two distinct opportunities for your practice:
Opportunity #1: Fill Your Current-Year Schedule
Between October and December, patients with existing benefits are motivated to use them before they expire or reset. This is your window to fill appointment slots that might otherwise go empty during the holiday season.
Opportunity #2: Position Your Practice for Next Year
Patients comparing plans for 2025 are actively thinking about their healthcare providers. If you're in-network with desirable Medicare Advantage plans and you reach out helpfully during this period, you increase the likelihood they'll choose plans that include you in-network and schedule with you in the new year.
Both opportunities require the same basic approach: proactive, helpful outreach to your Medicare patient base.
The Proactive Outreach Strategy
Most practices wait for patients to call them. But during Medicare Open Enrollment, the most successful practices flip this dynamic—they proactively reach out to help patients navigate their benefits and schedule care.
Here's how to implement this systematically:
Step 1: Identify Your Medicare Patient List
Pull a report from your practice management system showing:
All patients aged 65+ (likely Medicare-eligible)
Patients with Medicare listed as primary insurance
Patients who haven't been seen in 12+ months
Patients due for routine exams
Diabetic or glaucoma patients due for monitoring
Sort this list by:
Priority 1: Medical necessity patients (diabetics, glaucoma suspects, macular degeneration) who are overdue
Priority 2: Medicare Advantage patients due for routine exams who have vision benefits
Priority 3: All other Medicare patients who haven't been seen this year
This is your outreach list. Depending on your practice size, this might be 100-500+ patients.
Step 2: Create Your Outreach Message
The key to effective Medicare Open Enrollment outreach is being helpful, not pushy. You're reminding patients about benefits they already have and offering convenient scheduling—not selling them something they don't need.
Phone script for front desk:
"Hi Mrs. Johnson, this is Sarah calling from [Practice Name]. I wanted to reach out because Medicare Open Enrollment just started, and we're helping our patients review their vision benefits before the end of the year.
We show that you're due for your annual eye exam, and this is a great time to schedule before plans reset in January. Your [current plan name] covers your routine exam, and we want to make sure you're able to use those benefits.
Would you like me to get you scheduled? We have some availability in [early December/late November] that would work perfectly."
If they mention they're comparing plans:
"That's great that you're reviewing your options! If you'd like, I can share which Medicare Advantage plans we're in-network with, so you can consider that as you compare. We're also happy to answer any questions about vision coverage if that would be helpful."
If they're uncertain about their benefits:
"I completely understand—Medicare can be confusing. If you'd like, we can verify your benefits when you come in for your appointment. That way you'll know exactly what's covered before your exam."
Email/text message version:
"Hi [First Name], Medicare Open Enrollment is now underway (Oct 15 - Dec 7), and we wanted to remind you that it's a great time to schedule your eye exam before your benefits reset in January. We have convenient appointment times available in [November/early December]. Reply to this message or call us at [phone number] to schedule. We're here to help!"
Step 3: Train Your Front Desk Team
Your front desk team needs to be comfortable discussing Medicare benefits and handling common questions. Schedule a 30-minute training session covering:
What to say:
The phone and email scripts above
How to handle objections ("I'm not sure I need an exam" → "Many patients don't realize how important annual eye health monitoring is, especially with conditions like glaucoma that have no early symptoms")
How to offer convenient scheduling options
How to position the call as helpful service, not sales
What to know:
Which Medicare Advantage plans your practice accepts
Basic differences between Original Medicare and Medicare Advantage regarding vision coverage
How to verify benefits quickly (what information to look up before calling)
Who to transfer to if patients have complex insurance questions
What NOT to say:
Don't give specific benefit advice (you're not insurance advisors)
Don't pressure or use aggressive sales language
Don't make promises about coverage without verification
Don't criticize their current plan or insurance choices
Role-play the script until your team feels natural and confident. Have them practice handling common scenarios:
Patient says they just had an exam (when? was it routine or medical? are they due for follow-up?)
Patient is switching plans (offer to share which plans you accept)
Patient is unsure about their benefits (offer to verify before their appointment)
Patient declines (note in their chart, wish them well, remind them you're available when they're ready)
Step 4: Create a Calling Schedule
Don't try to call your entire Medicare list in one day. Spread the outreach over several weeks:
Week 1 (Oct 15-21): Priority 1 patients - Medical necessity (diabetics overdue, glaucoma monitoring, etc.)
Week 2 (Oct 22-28): Priority 2 patients - Medicare Advantage with routine vision benefits, due for annual exams
Week 3-4 (Oct 29-Nov 11): Priority 3 patients - Other Medicare patients who haven't been seen this year
Week 5-6 (Nov 12-25): Follow-up calls to patients who didn't answer initially
Week 7-8 (Nov 26-Dec 7): Final push before Open Enrollment ends
Set daily calling goals: If your front desk makes 20-30 outreach calls daily during slower periods, they can contact 200-300 patients over the eight-week period.
Step 5: Prepare Your Scheduling Availability
Before you start calling patients, ensure you have appointments available to offer them. Nothing is more frustrating than motivating someone to schedule only to discover you're booked solid until February.
Block dedicated Medicare appointment slots in late November and throughout December specifically for this outreach campaign. If you typically have 4-5 open slots weekly during this period, you now have 20-25 appointments dedicated to Medicare patients responding to your outreach.
Offer extended or weekend hours if possible during this period. Many senior patients are more available during non-traditional hours, and offering Saturday appointments can be a significant differentiator.
Train your scheduling staff to prioritize these outreach-generated appointments. When Mrs. Johnson calls back in response to your outreach, she should be able to get scheduled within 2-3 weeks maximum.
Supporting Your Outreach with Marketing Materials
While personal phone calls are the most effective outreach method, support your efforts with complementary marketing:
In-office signage: "Medicare Open Enrollment is Here! Ask us about scheduling your eye exam before your benefits reset in January."
Social media posts: "Medicare Open Enrollment runs October 15 - December 7. If you're comparing plans or want to use your vision benefits before year-end, we're here to help. Call us to schedule your eye exam or ask questions about coverage."
Email newsletter: Send a dedicated email to your Medicare patient base explaining Open Enrollment, what it means for their vision care, and how to schedule.
Website banner: Add a temporary banner on your homepage during October-December promoting Medicare scheduling.
Google Business Profile post: Create a post about Medicare Open Enrollment and your availability to see patients before year-end.
These supporting materials reinforce your message and create multiple touchpoints for patients who might need several reminders before taking action.
Handling Common Objections and Questions
Your front desk will encounter predictable responses during outreach. Here's how to handle them:
"I just had an eye exam." "That's great! When was your last visit? If it was within the past year and everything looked good, you're all set. We'll reach out next year when you're due. Is there anything else I can help you with today?"
"I can't afford it." "I completely understand budget concerns. The good news is that your Medicare Advantage plan covers your annual eye exam at no cost to you. We're in-network with [plan name], so there's no copay for your routine visit."
(Verify this is actually true for their specific plan before making this claim)
"I don't have any vision problems." "That's wonderful! Annual eye exams are actually about more than vision—they help us detect serious conditions like glaucoma, diabetic retinopathy, and macular degeneration early, often before you notice symptoms. Think of it like preventive care, similar to your annual physical."
"I'm switching plans and don't know what I'll have yet." "That makes sense. We're in-network with most major Medicare Advantage plans in the area, including [list 3-4 common ones]. If you'd like, I can share our full list of accepted plans so you can consider that as you compare. Or, we can schedule you for early January once your new plan is active."
"I'm too busy with the holidays." "I completely understand—the holidays get hectic! We have some appointments available in early December before things get really busy, or we can get you scheduled for January right after the new year. Which would work better for you?"
"I'll call back later." "Absolutely! I don't want to pressure you at all. Just wanted to make sure you knew about your benefits and had our number handy when you're ready. Can I send you a text or email reminder with our contact info?"
(Then actually send the reminder and note in their chart to follow up in 2-3 weeks)
Measuring Your Results
Track the success of your Medicare Open Enrollment campaign so you can refine it for next year:
Key metrics to monitor:
Calls made: How many outreach attempts did your team complete?
Contact rate: What percentage actually answered or responded?
Appointment conversion rate: Of those you reached, what percentage scheduled?
Show rate: Did these appointments have higher or lower no-show rates than typical?
Total appointments generated: How many additional appointments filled because of this campaign?
Revenue generated: What was the total production from these appointments?
Example calculation:
Calls made: 250
Patients reached: 150 (60% contact rate)
Appointments scheduled: 45 (30% conversion rate)
Appointments kept: 40 (89% show rate - actually higher than typical because these patients actively chose to schedule)
Average revenue per appointment: $350
Total campaign revenue: $14,000
If your front desk spent 25 hours total on outreach calls (2-3 hours weekly over 8 weeks), that's $560 per hour of outreach time—an exceptional return on effort.
Making This an Annual System
Once you've implemented Medicare Open Enrollment outreach successfully, systematize it so it happens automatically every year:
Create a playbook documenting:
When to start (October 15)
Who to call (Medicare patient segments)
What to say (scripts and objection handling)
How to track (metrics and reporting)
When to follow up
Add it to your annual marketing calendar as a major campaign, like back-to-school or holiday promotions.
Train new staff on this process as part of onboarding, so institutional knowledge doesn't walk out the door when team members change.
Review and refine each year based on what worked and what didn't. Your second year will be more effective than your first, and your third year more effective than your second.
The Service Mindset
Throughout this process, maintain the perspective that you're providing a valuable service, not making sales calls.
Many Medicare patients are genuinely confused about their benefits, uncertain when they should schedule care, and appreciative of practices that reach out helpfully rather than waiting passively.
When you call Mrs. Johnson and she says, "Oh, I'm so glad you called—I've been meaning to schedule but didn't know if my plan covered it," you've just demonstrated why this outreach matters.
You're not interrupting people's lives with unwanted sales calls. You're helping existing patients navigate a confusing system, use benefits they've paid for, and receive preventive care that protects their vision.
That's good medicine and good business.
Take Action This Week
Medicare Open Enrollment started October 15th and runs through December 7th. That means you're already into the window—don't wait another week to begin.
Monday: Pull your Medicare patient list and prioritize it
Tuesday: Train your front desk team on the script and objection handling
Wednesday: Block dedicated appointment availability in November-December
Thursday-Friday: Begin outreach calls with your Priority 1 patients
Ongoing: Make 20-30 calls daily during slower periods through early December
The practices that execute this strategy consistently see 30-50 additional appointments scheduled during a period that's typically slow. That's $10,000-20,000+ in additional production from patients who were already in your database—no new patient acquisition cost required.
Don't let this season slip by quietly. A few thoughtful calls now can make a significant difference in your December numbers while serving your patients genuinely well.
Medicare Open Enrollment is happening right now. The question is whether your practice will participate proactively or miss the opportunity entirely.
