A needs assessment is an important tool for Medicare agents. It allows you to gather comprehensive information about clients, which in turn enables you to guide them to the Medicare coverage that best fits their individual needs.
How to Conduct a Needs Assessment
A good needs assessment creates a guide for you to follow during your meetings with clients and ensures you don’t miss any relevant information. It creates a two way conversation between you and your client that helps them feel involved in the decision making process. It helps your clients understand what factors you are considering before recommending a plan. This creates an atmosphere of trust and understanding.
In order to conduct an effective needs assessment, you should prepare your clients ahead of time for what to expect when you meet. This includes what information they should bring with them such as a list of their medications and dosages, where they fill their prescriptions, a list of the doctors they see, and their preferred hospitals..
Encourage your clients to ask questions and check frequently to confirm they understand the information you are giving them.
What to Information to Review
- Medicare Eligibility
Start with the basics by confirming their Medicare eligibility. Are they just turning 65? Do they already have Parts A and B? If not, you will need to educate them on how to enroll before they can proceed.
- Current Insurance
Whether they are coming from employer based insurance or another Medicare plan, there will likely be some differences in the way coverage works, and you will need to explain these differences. This is also a good opportunity to ask if there are specific things they like or dislike about their current coverage. This information can help direct you to finding a plan that better meets their needs.
- Prescription Medications
Finding the right coverage means checking the drug formulary for each carrier and plan you might be considering. Confirm that their medication on the formulary, what tier it falls on, and what the cost will be. Check for any special requirements for the medication such as preauthorization or step edits. Confirm whether their pharmacy is in the plan’s network.
- Doctors and Hospitals
Review their list of doctors, specialist, and preferred hospitals to ensure they are in the plan’s network. If the plan offers dental, vision, or hearing benefits, check to see if there a special network of providers for these ancillary benefits.
- Special Health Concerns
Check to see if your client has a chronic condition or has any special health concerns for which they receive ongoing treatment. Review these specific benefits and any out of pocket costs. Check for any special requirements such as prior authorizations.
- Affordability
Before recommending any plan you should review all the out of pocket expenses involved including the monthly premium, any deductibles, copays, and coinsurances for both medical services and prescriptions to see If it falls within your clients budget. If you believe they qualify, you can educate them on state and federal programs that can help with out of pocket expenses.
- Lifestyle
Ask your client if they travel out of the area frequently and if so, how long they are away when they travel. Do they want the ability to see doctors while out of the area, or does emergency room and urgent care coverage meet their needs. You should explain the difference between HMO and PPO plans and the additional out of pocket costs for plans with out of network benefits.
Additional Best Practices
- Documentation
For consistency, use a printed needs assessment form and take detailed notes. Log the information in your CRM tool.
- Cross Selling Opportunities
Conducting a thorough needs assessment can uncover gaps in coverage that create opportunities for cross selling. Remember CMS guidelines only allow you to discuss health-related products at a Medicare meeting. To discuss non-health related products such as life insurance, annuities, and final expense insurance you must schedule a separate meeting.
The dedicated team at PTT Financial is here to support you and help you achieve your career goals. Contact us today.