During AEP, Medicare beneficiaries should review their coverage and decide if they need to make any changes. However, it can also be a time of confusion – in part due to the volume of Medicare advertising around this time of year. It’s your responsibility to guide your clients and prospects to give them peace of mind that they have chosen the right healthcare coverage for their needs.
Here are 10 of the most common questions asked during AEP:
1. How is my plan changing next year?
Many of your appointments during AEP will be with existing clients who want to know how their current plan is changing next year. Ask them to bring their ANOC letter with them to your meeting. Once you have reviewed any changes for the coming year, ask them how their plans are working for them. Have they had any changes to their medications or doctors or been newly diagnosed with a health condition that will require expensive tests or procedures? This will help you determine if their current plans are still right for them or if you should be looking at other plans that better fit the changes in their circumstances.
2. Do I have benefits I’m not using?
Medicare advertising during AEP often promotes the supplemental benefits many Medicare Advantage plans offer. This prompts some beneficiaries to ask if their plan also offers those benefits. It’s a good practice to review supplemental benefits with your clients, even if clients have been on the same plan for a while. They may have forgotten about benefits they did not need in the past but that could be beneficial to them now. Remind those with OTC benefits to use their dollars before they expire at the end of the year.
3. What is a Supplement Plan? Do I need one?
The slew of Medicare advertising on TV and in mailboxes can lead beneficiaries to be concerned that they don’t have the right coverage. This is an opportunity to educate clients and prospects on the types of Medicare coverage available.
4. Are all my doctors and hospitals in the network?
Most Medicare Advantage enrollees want to be reassured each year that all their doctors are still in their plans. Ask your clients and prospects to bring a list of their medical providers – including doctors, preferred hospitals, DME suppliers, etc. – to their meeting with you to confirm the providers’ participation in the MA plan your clients select. This is especially important for anyone who is considering changing plans because each carrier’s provider network is different.
5. Does the plan cover all my medications?
Prescription drug costs are a big concern for seniors on a budget. Ask clients and prospects to bring a list of their medications and the dosages to their meeting with you. Since each carrier’s drug formulary is different, you will need to check the formulary of each plan your clients and prospects are considering.
When reviewing medications and plans’ formularies, discuss:
- The tier the drug falls on and the associated costs, such as the deductible, copay, or coinsurance.
- The coverage gap or donut hole and how it might impact the client.
- Any special rules for clients’ medications, such as prior authorizations, step edits, or quantity limits.
- If the clients’ preferred pharmacies are in the network. If your clients travel, check if the pharmacy network allows them to fill prescriptions while they’re out of town.
- Any mail order requirements. Some seniors prefer mail order, whereas others like the option to pick their medications up at the pharmacy.
- The difference between Part B and Part D medications and how the coverage differs.
6. What other expenses can I expect?
It’s important to review and educate your clients on potential out-of-pocket costs, including the premium, deductibles, copays, coinsurance, and OOP maximum for medical services, as well as all the out-of-pocket costs associated with Part D coverage. Ensure there will be no surprises for your clients.
7. I am having trouble affording my healthcare costs. Is there anything I can do?
Some of your clients may struggle to afford their medications or other out-of-pocket costs and be unaware of the many programs available to help them. Make sure all your clients know about the variety of assistance programs available, such as Medicare Savings Programs, Medicaid, and State Pharmaceutical Assistance Programs, as well as how to apply.
8. Will I have coverage if I fall sick while traveling?
Is an HMO or PPO plan the best choice for your client? Some clients will be satisfied with an HMO, as this covers urgent and emergency care nationwide. Others may travel more extensively or want the option for out-of-network care if they fall sick. They may be willing to pay more for a PPO plan that provides the out-of-network benefits they want for those “just-in-case” scenarios.
9. Can I change plans during the year if my circumstances change?
Most people choose a plan based on their current circumstances. They may be concerned about unforeseen changes to their health or travel plans and want to know if they can change plans mid-year if something happens. Educate clients on the different Medicare Enrollment Periods and Special Circumstances that allow them to change plans during the year if they qualify.
10. What is the 5-star rating? Does my plan have five stars?
If there are 5-star plans available in your local area, it’s likely that your clients will have seen advertising promoting them. Although five stars indicate CMS has rated a plan as “excellent,” ensure your clients also consider other important factors, including affordability, the network of providers, and the drug formulary. If they do enroll in a 5-star plan, let them know they will have the extra benefit of a 5-star SEP, which will allow them to switch plans during the year.
AEP is the ideal time to build relationships and prove your value to your clients and prospects. When you educate seniors on Medicare benefits and help them find the best coverage for their needs, they feel empowered to make informed decisions about their healthcare.
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