Building a Strong Medicare Advantage Portfolio

What does a strong Medicare Advantage portfolio look like? It largely comes down to having a good spread of plan options.

The right plan for a client will depend on their specific needs.

They could be most concerned about the network for their plan, the prescription costs, out-of-pocket exposure for certain services, value-added benefits, the list goes on.

But by having multiple plan options, you can make sure you’re ready to meet the needs of any client.

Plan options include HMO plans, which can provide lower out-of-pocket costs for those that are comfortable with MA network restrictions. HMO plans provide coverage for all Medicare covered services; however, these services must be offered by providers that are in a strict network and may require referrals from their Primary Care Physician before having any service or procedure completed by a specialist or other provider.

PPO plans work well for those concerned about the narrow network restriction aspects of Medicare Advantage HMO plans. PPO plans may provide the enrollee the ability to seek services from a wider network of providers will maintaining the same or slightly higher copays for out-of-network providers. Keep in mind that all providers, even those out-of-network must still be Medicare participating providers. There are some PPO plans that will allow beneficiaries to use any Medicare participating provider at the same copay cost as an in-network provider.

D-SNPs are created specifically for beneficiaries who are eligible for both Medicare and Medicaid. D-SNPs also know as Dual Eligible Special Needs Plans follow different eligibility requirements. First and foremost, the beneficiary must qualify for Medicaid benefits. Medicaid, unlike Medicare, is offered and managed through the states but is monitored through CMS, The Center for Medicare and Medicaid Services. There are also other Special Needs Plans, each of which follow specific guidelines. Due to the volume of information pertaining to Special Needs Plans they will be covered in their own module.

And finally, MSAs are a good option for clients with low health costs who are financially secure enough to cover out-of-pocket costs in the short term, if necessary.

MSA plans are zero dollar premium by law, there is no network, in fact MSA’s are accepted by many Medicare participating providers across the entire U.S.

The are the only MA plan that gives its members money and has special tax advantages. Both the balance and qualified expenditures are not taxed.

Examples of clients who would do well with an MSA include travelers and snowbirds, HSA fans, individuals who are in-control of their chronic conditions, health enthusiasts, and Medicare Supplement enrollees just to name a few.

Now, I’ll admit, finding the top MA carriers in your market is not quite as straight-forward the finding the lowest premium, like we did for Medicare Supplement plans.

But here at Ritter, we do have a feature on our quoting tool that can give you a starting point.

You can see how many Medicare eligible are enrolled into each plan within a county.

For each county that you sell in, run a quote on our quote tool for each plan type mentioned, HMO, PPO, D-SNP, and MSA.

These are the most commonly sold plans in your market, and are likely to be a top option when narrowing down plans to recommend for clients.

Remember, contracting with each carrier will usually provide you with a number of plans covering different plan types, so you may be able to build a strong portfolio from just two or three carriers.

Keep in mind that only current year plans will show enrollment data on our Medicare Quote Engine. However, shortly before the beginning of AEP a toggle switch will be added to the Medicare Quote Engine which will allow you to view a preview of the next year’s plans. The toggle will stay in place through 11/30 of the current year to allow for current year plan reviews for clients who will qualify for a 12/1 effective date.

And don’t worry, we will talk more about planning ahead for AEP in another lesson from this course module.

For now, though, your portfolio should really be starting to take shape.

Mentioned in this Lesson:

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