Every year, Medicare enrollees have the opportunity to switch plans during the annual election period. While staying in the same plan may seem like the easiest choice, it’s not always the best choice, especially if anything has changed since joining the plan. Knowing how to assess a Medicare plan’s fit is a critical part of serving your clients.
Here are a few things to consider when taking stock of a Medicare plan for your clients:
- Doctors
Are all of your client’s doctors, specialists and hospitals covered in network? Have they encountered any situations where they are not?
- Prescriptions
Are all of your client’s prescriptions covered and are they paying what you expected? Have any of their medications changed tiers? Have they experienced any issues with prior authorizations, mail order, or the pharmacy network?
- Out-of-Pocket Costs
Are your client’s deductibles, copays, and coinsurances what they anticipated? Are there unexpected costs they weren’t planning for?
- Ancillary Benefits
Is your client using all of their benefits? Most Medicare Advantage plans include extra benefits such as dental, vision, and hearing. Some plans include gym memberships, massage, chiropractic, over the counter rewards and more. It’s easy to forget or overlook many of the ancillary benefits included in a plan. Are there benefits they don’t have that they wish they did?
- Circumstances
Changes in your client’s situation can impact a plan’s fit. For example, does your client have a new medical diagnosis, and treatment of this condition means they are seeing new doctors or taking new medications that weren’t considered when they chose their current plan? Or perhaps their change in circumstances means they are paying for benefits they no longer need. Also consider non-medical changes. For example, are they traveling out of the area more than they had planned?
- Finances
Have your client’s finances changed, making their Medicare coverage difficult to afford? If so, they may qualify for additional assistance offered through state and federal programs. On the other hand, if their financial situation has improved, they may be able to afford more robust benefits.
Changing Plans Outside of AEP
In most cases, Medicare enrollees cannot switch plans mid-year, but in some circumstances, they might qualify for a Special Enrollment Period. If they live an area where a 5-star Medicare plan is available, they can use the 5-star Special Enrollment Period to switch plans. They can only use this enrollment period once between December 8 and November 30 the following year, so they want to be sure the new plan covers all their needs before switching.
Medicare Advantage plan members can also leverage the annual Medicare Advantage Open Enrollment Period to change their plan selection. This period runs from January 1 to March 31 every year and gives enrollees who are unhappy with their plan selection an opportunity to switch. (Compliance warning – Medicare agents are NOT allowed to market the Medicare Advantage Open Enrollment Period.)
Supporting Your Clients
When you help a client enroll in a plan, you hope they’ll be happy in it. However, this isn’t always the case. Whether it’s because the client’s situation has changed or because there are unexpected issues with the plan, it may end up being a poor fit.
- Make sure your clients know they can come to you if they have any problems or concerns.
- Check in on your clients periodically to see how they’re doing.
- Encourage your clients to use their benefits, especially ones that come with no out-of-pocket costs. For example, you can remind your clients when it’s time to get their annual flu shots.
- Help your clients find and use additional resources. For example, if they’re having financial difficulties, they may qualify for financial assistance through federal programs such as Medicare Savings Programs and Extra Help , or state programs such as Medicaid and Texas Rx Assistance Programs.
Keeping your clients happy year-round is the key to client satisfaction and retention. PTT agents have access to product training, premier carrier contracts, marketing opportunities and more. See how PTT can help you.