The Annual Enrollment Period (AEP) has come and gone, and we’re in the midst of the Medicare Advantage Open Enrollment Period (OEP).
How can you make the most of this Special Election Period (SEP)? By selling prescription drug plans (PDPs)!
Who Gets Medicare Part D?
Those who are Medicare-eligible may require more prescription drugs than younger clients.
According to the National Council on Aging, nearly 95 percent of older adults have at least one chronic condition and nearly 80 percent have at least two.
Additionally, while those over 65 only accounted for one in six Americans in the most recent census, almost 90 percent of older adults use at least one prescription drug per month while 36 percent regularly take five.
Those with prescriptions for chronic conditions like arthritis, hepatitis C, multiple sclerosis, and cancer find themselves paying through the nose for their medication without adequate coverage.
With the average cost of cancer treatment around $42,000, it’s essential to help them get the drug coverage they need, which might be a Medicare Part D plan!
Selling PDPs During the MA OEP
Where Is the Opportunity?
During AEP, your clients may decide to enroll in a private health plan. But, with their high out-of-pocket exposure and network restrictions, beneficiaries sometimes find that their new Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plan is not the right fit.
If these beneficiaries are new to Medicare and enrolled in an MA plan during their Initial Coverage Election Period (ICEP), they can switch back to Original Medicare during the MA OEP, which runs from January 1 to March 31.
If they make the switch, your clients can pick up a Medicare Supplement plan, which has less out-of-pocket exposure and no networks, to fill in their coverage gaps. However, they will also need to join a PDP in order to avoid paying a penalty for not having prescription drug coverage and to cut down the costs of their prescription drugs. That’s where you come in.
If your client goes without creditable drug coverage for any continuous period of 63 days or more after their Initial Enrollment Period is over, they may be required to pay a penalty. That’s why even clients who don’t take prescription drugs may require your help.
By selling PDPs during the MA OEP, you can help your clients get the coverage they need. Beneficiaries can only change PDPs during their initial enrollment period, AEP, the MA OEP, or an SEP.
PDP Selling Logistics
Selling PDPs follows the same CMS guidelines as MA plans. Scope of Appointments are required, and agents must complete Part D certification for each carrier that they wish to sell PDPs through. Certification requirements vary by carrier.
Shopping around for PDPs can be frustrating, and your clients could potentially enroll in a plan that does not meet all their needs. The need for drug coverage differs among shoppers because it depends on the clients’ prescription drugs. Additionally, coverage options vary by carrier and service area. Agents like you can help beneficiaries sift through their options.
Running a PDP quote is as simple as utilizing carriers’ PDP quoting tools or visiting Medicare.gov. Though, keep in mind that carriers post changes to their formularies immediately, ensuring their quote engines contain the most up-to-date information. It takes more time for Medicare.gov to update their information since they must receive the changes from the carriers and then post them.
Simplify the search for Medicare plans by using Integrity’s consumer-facing quoting and enrollment platform. Get started with PlanEnroll today!
How to Save Clients Money on Prescription Drugs
As an agent, doing a little research goes a long way when selling prescription drug plans.
One of the first things you should do is run your clients’ drugs through Medicare.gov to find plans that include their medication.
Enhanced or Plus plans typically offer more coverage on expensive drugs. Basic plans are best suited for clients looking for immediate coverage from a low-cost plan in order to prevent late-enrollment penalties.
While knowing your clients’ ideal plan type will help you find a better fit, there are still more factors to consider between carriers. Depending on the needs of your client, some plan aspects will be more important than others.
Each Medicare Part D plan includes the following:
- Monthly premium — the cost per month.
- Annual deductible — the amount members must spend before initial coverage begins.
- Initial coverage — the coverage that begins once the deductible is met.
- Catastrophic coverage — the stage members reach once they spend $2,100 out of pocket in a year.
Many people on Medicare are also living on a fixed income, so keeping your client’s financial situation in mind should be a top priority.
In addition to the varying costs for premiums, deductibles, copays, and coinsurance, plans vary in their drug pricing tiers as well as pharmacy networks.
Keeping your client’s financial situation in mind should be a top priority.
For that reason, convenience is key. Your clients will more than likely want to enroll in a plan that features their local pharmacy as a preferred pharmacy. Carriers will typically offer members lower out-of-pocket costs when filling prescriptions from a preferred pharmacy.
PDPs lower the cost of current and future drugs your clients’ doctors may prescribe and offer beneficiaries peace of mind.
If your client is in need of Part D coverage, and you don’t offer it, another agent may come to their aid. Be a one-stop shop for your clients. Protect your business by making sure you have a PDP in your portfolio.
Not affiliated with or endorsed by Medicare or any government agency.
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