Medicare open enrollment period: 10 steps to guide your clients

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The annual Medicare enrollment period – also known as AEP or the Fall Medicare Open Enrollment Period – can be a time of optimism and opportunity, as beneficiaries have the opportunity to improve their benefits. Open enrollment in Medicare lasts from October 15 to December 7 of each year.

But that 54-day period each fall can also cause a lot of confusion, as many older people find themselves lost in a sea of ​​options, demands and deadlines.

As an advisor, it’s your job to guide your client through the Medicare maze. I compare it to running alongside your client rather than just pointing to the finish line.

Here is my 10-step process for guiding clients through the potential confusion around EAF Medicare. You can add your personal touch to it, but these basics serve as a general guide that most agents can follow.

1. Find out about their current coverage and what is missing.

Advisors can be too quick to start talking about the latest and greatest plans without first getting a feel for their clients’ current benefits and things they are looking to improve. I start every initial conversation with a new client by asking them questions about their current plan as well as their likes and dislikes.

How does their current plan fit into their budget? Are there any areas of benefit where they would like to have more coverage? Can they see their favorite doctors in the most convenient places?

These are just a few of the questions to ask yourself before embarking on diet options for the coming year.

2. Determine what type of diet is best suited to their needs.

There are three basic types of private health insurance, and it is important to give a basic breakdown of each and the role it plays. Customers often do not have a clear idea of ​​the difference between Medicare Advantage, Medicare Part D, and Medicare Supplement insurance. It is therefore your job to educate them and help them determine which combination of covers best meets their needs.

This is also a good time to confirm your client’s eligibility. Medicare has a lot of eligibility rules for its various plans, and just because a person is a Medicare beneficiary does not mean that they will be eligible for a particular Medicare Advantage, Medicare Part D or Medigap plan.

It’s not enough to just ask your client if they qualify and take their word for it, because chances are they won’t know it. Go through each eligibility criteria for the type of plan they are interested in and make sure each box is checked.

3. Gather the options.

Once you know the types of health insurance plans that can meet the needs of your clients, it is finally time to put the options together.

In 2021, the average Medicare beneficiary had access to 33 different Medicare Advantage plans, which is the highest number of options per beneficiary in at least a decade. But collecting all of your client’s plan options is just the start. In steps four through nine, you will gradually reduce them to a few.

4. HMO or PPO?

If a Medicare Advantage plan is the right choice for your client, you’ll want to help them carefully consider what type of plan structure will work for them. Most Medicare Advantage 2022 plans are HMO or PPO plans.

A member of the HMO plan can benefit from a managed care approach, and will typically need to see a physician, provider, or network facility for all services to be covered. Members of the PPO plan, however, may have the option of seeing non-networked care providers, although they may pay a higher additional fee than if they saw a networked provider.

If network restrictions are a concern for your client, they may consider a Medicare supplement plan (Medigap), as Medicare supplement plans have no network restrictions and are accepted by any physician, hospital, facility, or provider. who accepts Medicare.

5. Do they prefer lower premiums or lower copayments and deductibles?

Some plans offer a higher monthly premium in exchange for a lower deductible, co-payment, or coinsurance, or $ 0. These plans allow members to better forecast their annual health expenses and can facilitate budgeting.

Other plans offer a lower monthly premium combined with higher deductibles, copayments, or coinsurance amounts. These plans keep a member down on up-front costs and can represent great annual savings when healthcare is not heavily utilized. However, this type of approach can result in higher and less predictable direct expenses when expensive care is required.

Remember to take into account annual spending limits. All Medicare Advantage plans come with an annual reimbursable spending limit, unlike most Medicare supplement plans (Medigap Plan K and Plan L are the two Medigap plans with personal spending limits).

It all depends on your personal preferences and you should be able to help your client eliminate multiple plans based on the above criteria.

6. What is their supplier preference?

Some people have a great relationship with their doctor and want to continue seeing them. Others may have a specialist they really like. And many people have at least one convenient pharmacy or clinic near their home.

Ask your client about their preferred healthcare providers and locations, and find out how important it is that these options are part of a preferred or accepted provider plan network. Much of the plans can be eliminated simply because they are not accepted by the customer’s preferred vendors.

7. Do they have specific conditions?

Some Medicare Advantage plans offer better coverage in some areas than others. And some Medicare Advantage plans (called special needs plans) are even tailored specifically for a particular health problem like diabetes or kidney disease.

While you may be somewhat limited in the questions you are allowed to ask your client, mentioning that some plans focus their benefits on certain conditions can open some doors. If they have a specific health problem that impacts the level of health care they need throughout the year, there may be a plan designed to meet their needs better than a general HMO plan. or PPO.

8. Don’t forget about pharmacare.

It is not uncommon for clients to skip pharmacare because they are not currently taking any medication. But I always remind them that just because they might not be taking prescriptions today doesn’t mean they won’t be tomorrow.

If they enroll in a Medicare prescription drug plan during EAF, your client may run the risk of paying out of pocket for the drugs they need over the course of a full year. Given the high cost of prescription drugs without insurance, that’s probably not a risk they want to take.

This is also a good time to remind your client of the Part D late enrollment penalty. A recent survey found that 80% of Medicare beneficiaries were unaware of this ongoing financial penalty. If your client goes 63 or more consecutive days without Medicare drug coverage (and if they don’t have other “reputable” drug coverage that covers at least as much of the prescription costs as a standard Part D plan) , and then eventually enroll for Part D coverage, they will have to pay the late enrollment penalty for Part D as long as they remain enrolled in a Medicare drug plan.

If your client is currently taking a prescription, you’ll want to confirm how the drug is covered and how much it costs with any plans being considered.

9. Don’t ignore quality.

The next thing I like to watch is the quality. Medicare rates all Medicare Advantage and Medicare Part D plans annually using a five-star rating system. This stage of the process is a good time to eliminate any poorly performing plans (typically rated 2 stars or less by Medicare).

10. Guide their decision.

Right now, you should only have a few plans to choose from. It may feel like a haircut at this point, but this is where you really show your worth. Some of the last deciding factors that I like to weigh include:

  • Additional additional benefits, which may include non-urgent transportation costs, gym and wellness program memberships, home meal delivery, etc.
  • Customer experience (online member portals, mobile apps)
  • Company reputation and credit scores

It’s OK to let your client sleep on their decision. After all, you just gave them a lot of information. But be sure to schedule a follow-up call and remind your client of the registration deadline and the late registration penalties that can result.

Use this 10-step process as a template to guide your clients through the AEP so that the two of you can cross that finish line together.

Christian Worstell is a licensed insurance agent and senior writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options. His work has been featured in media outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health and finance blogs.


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