Everyone on Medicare needs creditable prescription drug coverage and most people don’t want a late enrollment penalty. If you’re offering Medicare Advantage-only plans (Private-Fee-For-Service or Medicare MSA) or Medigap plans, you can cross-sell prescription drug insurance. We’ll tell you how!
If your clients want a Medicare Advantage plan, they can enroll in a Medicare Advantage Prescription Drug (MAPD) plan offering if available. Conversely, if your clients have, or will enroll in, Original Medicare and possibly a Medicare Supplement plan, they can obtain prescription drug coverage through a stand-alone prescription drug plan (PDP), also known as Medicare Part D coverage.
A small number of counties in a few states do not offer an MAPD plan. In these counties, individuals can enroll in a Medicare Advantage plan without prescription drug coverage (PFFS or Medicare MSA) and a stand-alone PDP.
Below, we outline a few best practices for selling PDPs. Do these seven things to quickly and efficiently set clients up with the right plan for their budget and needs, possibly boost your commissions, and build loyalty!
Note: If your clients have MAPD plans but plan to enroll in stand-alone drug plans, make sure they know they’ll be disenrolled from their current plan and enrolled in Original Medicare (Part A and Part B).
1. Ask Your Clients for a List of Their Prescriptions Right Away
After having your clients sign a Scope of Appointment (SOA), one of the first things you should do is ask them for a list of their prescription drugs. Knowing what medications (especially high-cost prescription drugs) they take is imperative for finding them the right plan with the formulary that will cover their drugs. After all, you are looking for a plan to help pay for their current or future prescriptions, and different plans help cover certain drugs differently. It’s your job to help them find the plan that makes their prescriptions the most affordable.
Asking all your clients for a list of their prescriptions and then manually entering those drugs into a CRM sound time-consuming?
Work smarter, not harder with the Client Sync feature in PlanEnroll, a consumer-facing platform where those eligible for Medicare are empowered to learn, explore, compare, and enroll in a Medicare plan! Invite your clients to enter their prescriptions in their own profile, saving you considerable time and effort and minimizing mistakes. Learn more about how PlanEnroll can make your life easier
2. Find Out If They Qualify for Financial Assistance
There are government and state programs that can help make your clients prescriptions and prescription drug coverage more affordable for them. For example, the Medicare Extra Help program (also known as the Part D low-income subsidy) aims to assist eligible beneficiaries in paying the copays, premiums, and deductibles of their PDPs.
To be eligible, your clients’ incomes and assets must be below certain levels determined by their state. Those who have full Medicaid coverage, membership in a Medicare Savings Program, or Supplemental Security Income benefits automatically qualify for the program.
If your clients can’t get Extra Help, they may qualify for a state pharmaceutical assistance program (SPAP). SPAPs can pay for your clients’ Part D coverage entirely or at least lower the cost of their prescription drugs. Their availability and eligibility requirements can be found on Medicare.gov and vary by state.
According to CMS, three million people are eligible for Extra Help but not enrolled. Programs like Extra Help and SPAPs can save your clients thousands of dollars on their prescriptions annually, so it’s important you help spread the word about them.
Furthermore, because your clients’ financial circumstances can change at any time, it’s important that they contact you if their income or resources decline. Beneficiaries who become newly eligible for Medicaid or Extra Help qualify for a Part D Special Enrollment Period to enroll in a new plan.
3. Use MedicareCENTER to Compare Plans
Once you have your client’s updated list of medications and have determined if they qualify for additional help, you can get to the core of your work: finding the right PDP for them.
If your clients have entered in their relevant information through PlanEnroll’s Client Sync, quoting PDPs becomes extremely simple. As their agent, you can manage your client’s info and run tailored quotes from MedicareCENTER, a powerful client management tool.
MedicareCENTER draws all your client’s information that they’ve entered in their PlanEnroll profile, including their preferred pharmacy, drugs, and zip code. This feature makes the quote accurate to your client, quickly giving you a good idea which PDPs will be the right fit.
4. Narrow Down and Recommend a PDP
As you’re searching, your top priority should be finding PDPs that work with your clients’ medical needs. Examine plans’ copays, premiums, deductibles, and network restrictions next. If a client is unwilling to try less expensive drugs first, make sure you’re looking at plans that don’t require step therapy. Additionally, check if plans work with programs that can offer your clients help with paying for prescriptions.
When it’s time for you to help your clients make their final decision, provide the best recommendations you can. Do they take several generic drugs? Suggest plans with low copayments. Don’t have many prescription drugs? Advise they go with a low-premium plan. You’re the experienced professional. Show your clients you know your stuff.
5. Make Sure Your Clients Understand Their New PDP
A survey of over 5,000 Americans revealed that nearly 40 percent of insured individuals struggle to understand what their health insurance covers. Another study shows that just over 50 percent of people aren’t confident with basic insurance terms.
Teaching your clients what basic health insurance terms mean is a great way to set yourself apart from your competition and add value to your services. Making certain your clients know how much they will pay for their prescriptions during the three phases of a Part D plan’s coverage is also a good move. Doing so can build your credibility and your clients’ trust in you.
6. Let Them Know Other Ways They Can Save
Another way to lock in your role as an experienced professional is to inform your clients of other ways they can reduce their out-of-pocket expenses. Oftentimes, they can spend less on their prescriptions by switching to generic or brand-preferred drugs. Ask them if they’re aware of that.
Additionally, check to see if your clients can save money by utilizing their plan’s in-network, preferred pharmacies or mail-order pharmacies, and let them know if they can. Even the pharmaceutical companies that produce your clients’ drugs may offer assistance programs to help cover the costs. See if your clients qualify for one or more of these programs at Medicare.gov/pharmaceutical-assistance-program.
Don’t forget to confirm your clients know that they have a right to ask their plan to cover a prescription drug. Their provider can ask their plan for an exemption if a drug in a lower tier doesn’t exist or won’t work for them. Providing all this information to your clients will show them you truly have their best interests in mind.
7. Encourage Your Clients to Reevaluate Their Plan Every Year
Though seniors can change their PDP every year, research shows few review and consider switching plans during the Annual Enrollment Period (AEP). KFF found that nearly seven in 10 people with a Medicare plan did not compare their Medicare coverage options during the 2022 Open Enrollment Period, which means the majority of beneficiaries might be missing out on finding a plan that suits them better.
So lastly, at your final appointments with clients, stress to them the importance of reevaluating their PDPs during AEP. What was their best option one year, may not be the next. Plans can change their premiums, copays, deductibles, formularies, network, and preferred pharmacies.
Additionally, your clients could become newly eligible for additional help. Express to your clients that you’re more than happy to help them shop around and ensure they know how to get in touch with you in the future. By tackling this topic, you’re not only giving them sound advice, but you’re also securing their future business.
PDPs are a natural cross-sell with Medicare Supplements and Medicare Advantage only plans. Those who employ these best practices when selling them will not only maximize their time, but also their production and profits.
Editor’s Note: A modified version of this post was previously published in the August 2017 issue of California Broker Magazine. This post has been updated to include fresh ideas and information more relevant to the 2025 Annual Enrollment Period.
Not affiliated with or endorsed by Medicare or any government agency.
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