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What is a DSNP

If you are an insurance agent or you have seen some of the Medicare commercials on tv, you have probably heard about dual eligible special needs plans or DSNPs.  This might make you wonder, what is a DSNP.

DSNPs are Medicare Advantage plans that provide specialized healthcare benefits to qualified individuals who have both Medicare and Medicaid benefits.

Why are DSNP plans a good choice

For many beneficiaries who qualify for dual-eligible healthcare benefits, it may be difficult to coordinate their health care benefits between Medicare and Medicaid. That is why the DSNP (special needs plans) area a good choice.  These plans provide members with an easy way to manage their healthcare coverage with the use of 1 plan as opposed to multiple plans and ID cards.

DSNP plans all include prescription drug coverage as well as some of the benefits in listed below.

Please note: each plan provides its own list of benefits.  To view a full list of benefits for a particular plan, check the Summary of benefits or evidence of coverage.

1. $0 plan premiums
2. Coordination of healthcare services
3. Dental benefits
4.  Hearing benefits
5.  Hearing benefits
6.  An allowance for OTC items
7.  Free transportation to and from doctor’s visits
8.  Fitness programs
9.  Telehealth services
10.  An allowance for healthy foods or other items

Who offers DSNP plans

DSNPs are offered to qualified beneficiaries through private insurance companies. The insurance companies that offer the plans are required to include all benefits that Original Medicare covers (Part A & Part B). Each individual state controls the extra benefits that providers can offer.  These plans are not available in all states.

You can quickly find out which plans are available in each state by running a quote on Connecture or Sunfire.

Click here to watch a quick YouTube video on using Connecture and Sunfire

There are different types of DSNP plans

Each type of DSNP is based on your level of eligibility for Medicaid.  Insurnace carriers offer a limited choice of DSNP plans based on the service area.  The level are as follows:

1. All-Dual
2. Full-Benefit
3. Medicare Zero Cost Sharing
4. Dula Eligible Subset
5. Dual Eligible Subset Medicare Zero Cost Sharing

Who is eligible for a DSNP plan

Beneficiaries may be eligible for a DSNP plan if they have dual coverage from both Medicare and Medicaid. In order to qualify for Medicare benefits you must:

1. Either be a US citizen or a legal resident for a minimum of 5 years.
2. Be 65 years old or have a qualifying disability if you are under 65 years old.
3. To qualify for free Medicare Part A, you need to have worked at a Social Security qualified job for at least 40 quarters (10 years).

In order to receive Medicaid benefits, you must:

1. Be a US citizen or meet other immigration requirements and reside in the state in which you qualify.
2. Have a valid Social Security number.
3. You must either be 65 or older or have a permanent disability as defined by the Social Security administration.
4. Have an income level that does not exceed your state’s income threshold.

Find out if you qualify for state Medicaid benefits

As a licensed insurance agent, you can help sort out all the plan choices as well as the additional benefits each plan offers so your clients feel confident in their plan choice.

Learn the difference between Medicare and Medicaid

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Common Medicare terminology

If you are getting started in Medicare sales, there are plenty of terms that can be confusing. This list of common Medicare terminology can help you moving forward with your Medicare sales career.

Ancillary products 

These are plans are offered by private insurance companies outside of Original Medicare or Medicare Advantage.   Some examples of Ancillary plans include life insurance, LTC policies, stand-alone dental or vision as well as many other stand-alone insurance products.

Annual Enrollment Period (AEP)  

During this time from October 15 through December 7 each year eligible beneficiaries can either enroll in or change their current Medicare coverage.

ANOC (Annual Notice of Change) 

Each year beneficiaries receive a letter from the plan they are enrolled in.  This letter explains any changes that the plan will have in January when the plan year begins. It lets beneficiaries know about cost and benefit changes. This letter arrives each fall so beneficiaries can decide if they want to change plans during the Annual Enrollment Period that starts in October.

Coinsurance 

This is the amount, usually a fixed percentage, the insured must pay toward a covered claim after the deductible is satisfied.

Co-payment 

The set fee a plan charges the insured at the time of each doctors visit or when you purchase prescription medication or other medical service.

CSNP (Chronic Condition Special Needs Plan)  

A type of Medicare Advantage plan for beneficiaries with specific chronic conditions such as end stage renal disease (ESRD).

Deductible 

The pre-determined amount you have to pay before your insurance coverage begins to pay for covered services.

Donut Hole aka the coverage gap 

This refers to a gap in your Medicare Part D prescription drug benefit.  This occurs when your prescription drug expenses exceed the initial coverage limit of your plan but have not yet reached the catastrophic coverage level.

Dual eligible Special Needs Plan (DSNP)

DSNPs are specialized Medicare Advantage plans that provide healthcare benefits to beneficiaries who have both Medicare and Medicaid.

Durable Medical Equipment (DME)  

DME refers to medically necessary, prescription healthcare devices that Medicare Part B usually covers. This includes things like wheelchairs, infusion pumps and blood sugar monitors, to name a few.

Extra Help (LIS, Low-Income Subsidies) 

These terms refer to a program that helps eligible Medicare beneficiaries with limited income pay for prescription drug coverage.

Formulary 

The list of drugs that each Medicare plan covers.  Each plan separates the drugs on the formulary by tier the tier corresponds to the price the plan member pays.

General Enrollment Period (GEP) 

Eligible beneficiaries who miss their Initial Enrollment Period, can use this time to sign up for Medicate.  The GEP runs from January 1 through March 31 and is only available to first-time Medicare enrollees.

HMO (Health Maintenance Organization) 

A type of Medicare Advantage plan that requires the selection of a primary care physician.  Your PCP will coordinate your care and needs to provide a referral if you need to see a specialist.

Hospice  

This is a type of healthcare for terminally ill patients that provides pain management, counseling, hospital care, and more. Coverage for hospice is included in Part B of Medicare.

Initial Enrollment Period (IEP) 

The time when eligible beneficiaries can first sign up for Medicare coverage. It begins three months before your 65th birthday and ends three months after. This is the time that most people enroll in Medicare.

In-network 

When a provider (doctor, hospital, pharmacy, etc.) is in-network, they accept your Medicare plan.  Beneficiaries who use in network providers are covered under their plan when you use in-network providers.

ISNP (Institutionalized Special Needs Plan)  

A type of Medicare Advantage plan for people living in nursing home institutions.

Medicare Advantage (Medicare Part C, MA/MAPD) 

A Medicare plan offered by private insurance companies.  These plans cover everything that Original Medicare covers as well additional benefits like prescription drugs, dental, vision, fitness, etc.  When they are called MAPDs they refer to Medicare Advantage plans that include prescription drug coverage.

Medicare Savings Programs (MSP) 

MSPs are Medicaid-run programs.  These programs help cover Medicare premiums and other cost-sharing expenses for people with low incomes. Eligible Medicare beneficiaries receive help with premiums, copayments, and deductibles.

Medicare Supplements 

A separate, private insurance plan that helps pay deductibles, and copayments for Medicare covered medical services.  These plans work with Original Medicare.

Open Enrollment Period (OEP) 

This enrollment period is available only to Medicare Advantage plan enrollees. It runs from January 1 through March 31. Enrollees can use it to switch between Medicare Advantage plans or to go back to Original Medicare and a PDP plan.

Out-Of-Pocket Limit (MOOP)

Many Medicare plans place a maximum dollar amount beneficiaries can spend out of pocket on their healthcare costs each year. Once they surpass the out-of-pocket limit, Medicare-covered services are 100% covered.

PDP (Part D)

PDP plans provide coverage for prescription drugs and are offered by private companies.

PPO (Preferred Provider Organization)

A type of Medicare plan that provides care through a specific network of medical providers and facilities.  Plan members can seek care outside the network, although it will usually cost more.  In most cases, PPO plans don’t require referrals to see a specialist.

Special Enrollment Period (SEP)

Eligible Medicare beneficiaries with special circumstances are entitled to enroll in Medicare plans outside of the traditional enrollment periods.

TRICARE

This is a healthcare benefit for both active duty and retired service members as well as their families.

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Medicare sales and cross selling

If you are selling Medicare, you should think about how to meet all the coverage needs of your clients. That is why Medicare sales and cross selling go hand in hand.  Before you try and do this, be sure you have the necessary product knowledge on anything you intend to offer.

A great way to get insight into your client’s potential needs is with a client needs assessment.  Each agent should tailor the assessment to include the applicable product lines they are licensed to sell and have a good knowledge of.

If your client understands that you are able to offer them coverage for all their personal insurance needs, they will be inclined to call you when they decide to add to their current coverage.  It is best to take care of their most urgent concerns before talking about additional items.

Watch our quick YouTube video on cross selling during AEP

Medicare sales cross selling – be aware of underlying health issues

If you conduct a needs assessment or spend enough time speaking with your client, you will probably find out if your client has any illnesses that will prevent them for obtaining some types of coverage that they will not qualify for.  If you ask about any recent claims they have had, this may be an indicator if they are a good candidate for some types of coverage.

Some other things to find out from your client

Is the client or their spouse presently working?  If the answer is yes, do they have any employer benefits and if so, what are they?

Have they ever served in the military (are they a veteran)?  Sometimes veterans receive benefits.  You need to find out if they do and what those are.

Medicare sales cross selling – Cancer, Heart attack and Stroke coverage

Because many people have a family history of either cancer, heart attack or stroke, this product is not difficult to sell. This product is sometimes called critical illness insurance.  Be sure you understand the client’s budget before you show them quotes from companies that will fill their coverage need.

Cross selling – Long Term Care Insurance

Most people do not have long term care coverage. Although LTC has changed over the years, there are still some good coverage options available.  There are some short-term care policy options that include home health coverage.  There are also some life policies that include an optional LTC rider.  You can ask your client if anyone in the family has needed home health or nursing home care. If they have, ask them if they know how it was paid for. Do they have a way to pay for it if they need it?

Cross selling – Life Insurance

Life insurance is not like LTC coverage because many clients have at least some life insurance coverage.  If you want to start a discussion about life insurance, you need to find out if the client already has coverage and if so, how much.  Once you get the answer, you can ask questions to determine if they have enough to cover what they need it for.

Here are some reasons people purchase life insurance:

To replace income lost due to the death of a family’s financial provider.

If they want to cover their final expenses.  If they have a policy in place, it may not be enough to cover their final expenses.  This means they may want to consider purchasing a policy that provides a bigger benefit amount.

Policies can help pay any outstanding debts owed by the policy holder.

In some cases, the policy holder wants to leave a financial gift to their chosen beneficiary.

If they do not have a policy, you may be able to help them decide if a policy could benefit their loved ones.

Cross selling – Final Expense

Final expense insurance is a kind of life insurance.  If the client does not have life insurance in place, this type of policy can help family members pay for their final expenses and avoid leaving them with a large bill after you are gone.

Cross selling – Annuities

These days many people want a safe place to invest their savings due to low interest rates at banks and stock market volatility. Simply ask your client if they are happy with their current rate of return on investments. Let them know a fixed indexed annuity can provide a dependable place to invest savings and a better return rate than many CDs.  In many cases, you can offer them an annuity product that will provide a better return that what they currently have.

Now that we have given you a few products to consider adding to your portfolio, it is up to you to decide what will be the best value add.

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Medicare fact finder

Each time a Medicare agent meets a new client a Medicare fact finder is a great way to address what they want and what they need.  This is a great tool to help you make personalized suggestions for coverage.

If you are in the senior market, your fact finder should focus on Medicare coverage.  It may also include additional options like hospital indemnity, life products or other relevant products you offer. You should design your fact finder to fit your client’s needs and the services that you have to offer.  The only way to know what the client is looking for is to ask questions.

We have a few examples of Medicare fact finder questions below:

1. Do you understand the different parts of Medicare

This question is very important to ask.  Clients need to understand the parts of Medicare and how they work to know what type of coverage they want and need.  Your job is to make sure they know about all the coverage options available and make an informed decision.  This includes what is covered by Part A, Part B, Part C and Part D.

2. Can you tell me what you like and don’t like about your current Medicare coverage

When you ask this question as part of your fact finder, you gain valuable insight into what type of coverage the client is looking for.  This will help sort out which benefits are important to them, and which are not. This can be very useful in sorting out MA/MAPD plan benefits as there are so many to choose from and they offer different benefit packages.

3. How often do you see a doctor or specialist

The answer to this question can help decide if a Medicare Supplement or a Medicare Advantage plan is a better option for your client. That is a reason to include it in your Medicare fact finder.  Many of your clients’ plan choices will come down to simple mathematics.  Medicare Advantage plans require a copayment for visits to either PCPs or specialists.  The amount of each copay can make a difference in your client’s budget.

4. Are there doctors and medical facilities that you like to use for your health care needs

If a client uses medical care from several providers on a regular basis, they may have a difficult time finding a Medicare Advantage Plan that all their chosen providers participate with.  It is your job to be sure they can continue to use the providers they want and are aware of the cost for each visit.  In some cases, an MAPD plan may not be the best option for the client.

5.  Find out if the client is currently taking any prescription medications and which pharmacy they like to use

Please be aware, it is up to the client if they want to disclose this information.  However, it is important to help them find the best coverage options for their needs and can be very costly if they make an ill-informed decision.   Each MAPD and PDP plan has a specific formulary.  This means they cover each medication differently. There can be very large differences in the cost for prescriptions that may place a burden on your clients when they are trying to maintain their health.

The cost of each prescription also depends on the pharmacy your client chooses to use.  This must be explained to them as well.  Carriers for Part D coverage often have preferred network pharmacies that can save the client money when they fill prescriptions there.

6. Does your client have any chronic health conditions

There are specific Medicare Advantage plans that provide coverage of certain chronic health conditions, such as ESRD.  Although they cannot enroll in most Medicare Advantage plans, these SNP plans cover their specific needs, and they cannot be denied coverage for pre-existing conditions.

7. Do they travel often or have a home in another state

This may be an important question to include in you Medicare fact finder.  Medicare supplement plans are good in any doctor’s office or facility that accepts Medicare assignment. On the other hand, Medicare Advantage plans have a local provider network and clients may not find an in-network provider when they spend months living out of their home state.  This can end up costing quite a bit out of pocket for care. It is important to check the benefits of each plan for travel and residency coverage.

8. Are they covered through a former employer or other organization

In some cases, client have retiree plans that work with Medicare to provide coverage for health care needs.  If this is the case, the client should check with their company’s benefits coordinator to see how a Medicare plan affects their retiree coverage and how they work together.

These are just a few possible questions to use.  It is important to decide which questions to add or subtract based on your personal preferences.

A few more thoughts

Let your client know what you are doing and why.  This will help them understand that you see each client as an individual and will do your best to fill their personal health coverage needs. It is best to finish the questions and go over the answers before you try and make any sales presentation to the client.  Making the suggestions at the end will let the client know you are listening to every answer and using all the information to make the most informed suggestions.

Click here for a SSA Medicare fact sheet

View free Medicare agent training videos on our Youtube channel

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Click here to view SEP_Report as of 4-28-25

Medicare SEPs for emergencies or disasters

There are a lot of moving parts to selling Medicare plans including several choices for Enrollment opportunities.  We will explain a little about the Medicare SEPs for emergencies or disasters.  This SEP may be available to some of your clients.

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Why contract with multiple Medicare carriers

If you are just getting started in Medicare sales it can be overwhelming.  I am sure there are many questions you have including why contract with multiple Medicare carriers. In this post we will provide an answer to that question.

As a Medicare agent, the main reason you chose this business should be to provide the best possible advice to individuals who are looking for Medicare coverage.  In order to do that, you need access to the best options for each individual.  In other words, you need to be able to offer plans from multiple Medicare carriers.

Avoid rapid disenrollment – learn more

Beneficiaries can compare several plans

Providing beneficiaries the ability to compare the benefits of several plans lets them make a well-informed decision on their coverage. Many clients like to see as many options as possible.  If you can provide information on many plans, they know you are giving them the best choices available, and they can feel more confident in their choice.  There is no need to go to other agents to view other options. Contracting with several carriers gives you a broader knowledge of the Medicare market and that is good for both you and your clients. A diverse portfolio ensures potential clients you will truly find the best plan for their personal needs.

Agents who contract with only one carrier, leave clients wondering what else is available and are they getting the best coverage. In this instance, clients do not have all the information available to get the best coverage.

Click here to learn about our quoting tools Sunfire and Connecture – watch a quick YouTube video

Plan pricing

One important factor for Beneficiaries is the cost of the plan they chose.  When you have many options available, it is far more likely to find a plan that offers the desired coverage at an affordable price.  This provides your clients a chance to find the plan that does not stretch the budget too thin once you inform them of all the costs associated with each plan and available benefits.

 Build your book

Medicare beneficiaries need an agent they trust who provides knowledge as well as the best plan options.  If your clients know you are available to address any concerns they have and you offer several great plan choices, they will tell their friends and family. Many Medicare beneficiaries are overwhelmed with information; bombarded by phone calls and mail.  If they have an actual person they can trust for sound advice, beneficiaries appreciate this. If your clients know you available to address any concerns they have and offer several great plan choices, they will tell their friends and family.  This is a fantastic and free way to generate new leads.  A good agent is a valuable asset and provides beneficiaries with peace of mind.

Learn how to make a business plan for you Medicare business

More opportunity to earn commission

Any agent who does not offer multiple carriers is leaving money on the table.  Our job as agents is to provide the coverage beneficiaries want.  If you offer only 1 or 2 carriers, you are letting many opportunities slip through your fingers.   Beneficiaries are presented with multiple plan choices every day and they know what benefits they want.  They also know what they can afford.  You need to be prepared to find them what they are looking for or someone else will.

Watch our YouTube video on how to choose Medicare carriers to contract with

Find out what a good FMO offers 

Wellcare OTC catalog 2024

If you are considering a Wellcare Medicare Advantage plan, you should take a look at the Wellcare OTC catalog 2024. In 2024,  Wellcare is providing beneficiaries of participating plans have access to Wellcare Spendables dollars.  Members of Wellcare plans can use this benefit purchase OTC items such as pain medication, vitamins or toothpaste.  Use the healthy foods benefit to purchase fruits and vegetables or bottled water just to name a few choices.

Use one of the catalogs below to search for some of the options available.  You will find more choices either online or in participating stores.

Wellcare OTC Healthy Foods 2024 – Click here to download

Download a copy of the Wellcare OTC 2024

When your Wellcare Spendables card arrives, you need to activate your benefit.  Do this either online at member.wellcare.com or by calling 1-855-256-4620 (TTY 711) there is someone there to answer your call 24 hours a day 7 days a week.  You can also access your benefit by downloading the Healthy Benefits+ mobile app for apple devices at the app store or for Google devices at googleplay.

Once you download the app, you can easily scan your card from your phone when you go to the checkout to purchase eligible items. Use the app to scan items and verify eligibility.  You can also use your app to shop online and place your order as well as check your available balance.

Find a participating store such as; Walmart, CVS or Kroger with the app or by checking your online account.

This catalog has many great options for members

The Wellcare OTC catalog 2024 includes several sections dedicated to specific conditions including a section for diabetes supplies.

Daily living aids, such as blood pressure monitors, scales and thermometers are also included.  There are also feminine health items as well as eye and ear care products.

Health Food benefits – Wellcare OTC catalog 2024

The store finder app can help members find more than 55 thousand retailers who participate with the Healthy benefits nearby.
There are many choices of different food categories to choose from such as meals & sides, protein drinks and even condiments.

A few more details

Online and in-store prices may vary from the prices listed in the catalog.  If this happens, the store price will be applied at the checkout.

Sales tax is applied to all orders.

If the cost of your order is more than the balance on your card, you can use another payment method to make up the difference.

To replace a lost card; just visit member.wellcare.com or call 1-855-744-8550 (TTY 711) between the hours of 8am and 8pm local time 7 days a week from October through March, the hours to reach customer service are 8am until 8pm Monday – Friday from April through September.

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Medicare Savings Plan CT 2024

The Medicare savings plan CT 2024 could make a big difference in the lives of many people struggling to pay their health care costs.

Connecticut provides financial assistance to eligible Medicare enrollees through Medicare Savings Programs.

Qualified beneficiaries receive help through one of three available Medicare Savings Programs.  qualification for each level depends on your income. If you qualify for any of the three levels, DSS will pay your monthly Medicare Part B premium. In some cases, enrollees receive help paying both Medicare deductibles and co-insurance. Medicaid funds the MSP program in CT.

The three levels of Medicare Savings Plan help

Each level of extra help is decided by your gross income.  If you are married, your spouse’s income is included. Every level of the MSP program pays for your Part B premium.  The monthly income limits are effective from March 1, 2023, until February 29, 2024.  After that date, the new income limits take effect.  When CT releases the new amounts, will add them in.

QMB – This level of help pays your Part B premium.  Part B covers doctor visits, some preventative care and outpatient hospital services.  QMB also covers your Medicare deductibles.  The deductible is how much you pay before your Medicare insurance starts to pay. QMB benefits also cover Co-insurance payments. Co-insurance is the part of Medicare approved services that beneficiaries are responsible for paying.

The QMB is the only level of the Medicare Savings Program that acts like a Medicare Supplemental or Medigap plan.  It will cover the costs of the deductibles or co-pays of Medicare Part A and Medicare Part B up to the Medicaid approved rate.  It will also pay the premium for Medicare Part A for qualified adults 65 years of age or older when they are not eligible for premium free Medicare due to work earnings.  You are protected by federal law from being “balanced billed” or billed for services after Medicare Part A and B pays its portion of the bill, if a provider agrees to treat you, whether or not the provider is a Medicaid provider.

SLMB – This level of extra help pays your Part B premium only.

ALMB – This level of extra help also provides payment for your Part B premium only. Help on this level is available on a first come first served basis as it is subject to available funding.   Beneficiaries who receive Medicaid are not eligible for this program.

Click here to download a quick benefits guide.

Every level of MSP automatically enrolls you into LIS (Low Income Subsidy) also referred to as Extra Help.  Extra Help either pays the entire cost of a benchmark Medicare Part D plan, or part of a non-benchmark plan.  It also covers the annual deductible, co-insurance and co-pays. Extra Help coverage stays the same even in the coverage gap (donut hole). Beneficiaries who receive the LIS also have additional SEPs to change Medicare Part D or Medicare Advantage plans if they want to.

How to Apply for MSP

You can apply for these benefits online, through the mail or by brining your application to a local DSS office. If you need help completing the application, you can authorize someone to do the application for you.

 Click here for a list of local offices.

To apply for benefits online, go to www.connect.ct.gov, look for the ‘Apply for Benefits” and go from there.  To apply for MSP only, complete the Medicare Savings Programs application/redetermination form below:

Medicare Savings Program Application (W-1QMB)

Formulario de Renovación de programas de ahorro de Medicare (W-1QMBS)

Click here to learn about Medicaid redetermination

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Medicare commission chargebacks

Medicare commission chargebacks are just a normal part of Medicare sales. If you plan ahead, you can avoid chargebacks turning into a bigger problem.

What is a Chargeback

In Medicare sales, a chargeback is when a portion of an agent’s commission for a sale is lost.  This happens when a client’s policy is terminated early.  This happens when a client either cancels their plan or passes away.  When this happens, the agent must pay back a portion of the commission they received previously.

Many Medicare agents choose to receive commission advances.  This means the carrier pays several months of commissions on the sale of a policy up front, before the client pays the premium payments.  This is great because you do not have to wait to get the payment, however this is also a potential problem if your client cancels their policy, and you incur a debt to the insurance carrier.

Please note: every insurance carrier has their own payment schedule and chargeback rules.

Be prepared for chargebacks

Because there are things you cannot predict, clients pass away or change their mind on their coverage choice, you need to be prepared for at least a few chargebacks each year. It is a good idea to have money set aside for such situations.

Pay Your Medicare commission chargebacks

This is a no brainer.  If you have a bill, you need to pay it.  If you neglect to pay it, you may have a Vector hit against you.  This is a service insurance companies use to report unpaid debts. This will harm your credit score as well as you chance to sell products with some carriers.  Some carriers will not contract brokers with a Vector hit until they pay their debt.

Agents can pay some chargebacks out of the commission the insurance company owes you.  If you do not have enough commission coming in to pay the debt, some carriers will allow you to set up a payment plan to clear the debit.

AEP Enrollments can lead to MA OEP Disenrollments

When enrollments occur during AEP (Oct 15 through Dec 7), agents receive half the commission for each sale in Jan and the other half in Feb.  Because full MA/MAPD compensation is only paid out once on each enrollee, agents receive renewal commission rates for each beneficiary who enrolls in a plan.  Agents receive full commission only if the beneficiary is a first-time MA/MAPD plan enrollee.

When your client decides to either move or drop their MA/MAPD plan during the OEP (Jan 1 through Mar 31), the agent receives a chargeback. Because another agent could talk your client into a plan change during the MA OEP, you may receive a chargeback.

Click here to find out about the MAPD commissions 2024

Medicare commission Chargebacks for Medicare Supplement sales

Luckily chargebacks for Medicare Supplements are a less common occurrence. Usually, carriers pay Medicare Supplement commissions as earned.  In other words, your client pays their monthly premium, then you receive commission.

In some cases, agents have the opportunity to receive advanced commission which are normally 3, 6 or even 12 months ahead of schedule. Because many carriers charge a nominal fee for advancing commissions, most agents opt for commission payments on an as-earned basis.  If you do get a chargeback for a Medicare Supplement sale, the amount is usually not very large.

Communicate with your clients – avoid Medicare commission chargebacks

It is extremely important to stay in contact with your clients.  If they know you are available to answer questions as a trusted and valuable resource, they will call you if they are thinking about a plan change.  This may help prevent them from seeking advice from another agent who may contact them.  If your clients change plans during AEP, it may be good advice to check to see if they are happy with the new plan after words.  If they are not, you will be able to enroll them in another plan instead of them going to another agent.

There is no way to predict losing a client due to death or other unforeseen reasons.  The best thing to do is let clients know you are available even when they are unhappy.  Remember to prepare ahead for a few chargebacks.

Learn a few Medicare sales tips

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What is a rapid disenrollment

How to prevent rapid disenrollment

If you follow all the CMS guidelines as well as listen to the client and found a plan that best fit their needs, a disenrollment will be unlikely to occur.   Take a look at a few suggested practices below to help you avoid rapid disenrollment.

Enroll clients in the plan that is best for them

The most successful Medicare agents, enroll clients in the plan that best fit the client’s needs.  They do not base their recommendations on the amount of commission they will receive. When you operate in the best interest of the client, a disenrollment is not likely to happen. If for any reason your client changes their mind about the plan they chose, it is in everyone’s best interest to help them switch to another plan.   This helps them to know you are there to provide them with the best service possible and they can contact you with any questions or concerns.

Check all your Clients’ providers

Most clients do not want to search for new doctors each year especially if they are happy with the care they are receiving.  That means it is imperative that you get an up to date list of their current providers and make sure they are in-network with any plan they are considering.  This is also important for hospitals or any other medical facilities they like to use.  Because paper directories are difficult to update in a timely manor, It is best to check the online provider directory of any plan they are thinking about enrolling in.

Get a list of current medications

These days mediations can cost thousands of dollars for each refill, therefore, it is important to get an updated list of medications from each client annually to provide the best possible coverage options.  When you run a plan quote, always look at where each medication falls on the formulary of each plan they are considering as well as the plan that provides them the best total cost.  This means include the cost of the plan as well as the cost of the medications for a total plan cost. Always include the name of the pharmacy your client uses as that also has an effect on the cost of their medications and the plan they choose.  Whenever possible, clients should use a pharmacy that is considered preferred by their plan.

Explain plan benefits and coverage costs

Be sure you understand the clients coverage needs as well as their budget. Be sure they know the cost of monthly premiums, co-pays, coinsurance and deductibles as well as prescriptions costs will be.  Unexpected costs are one reason people disenroll from a plan.

Always be sure your client understands the benefits of the plan they choose.  When they tell you they want a dental benefit; be sure they understand exactly what it covers and doesn’t. The same goes for any benefit that is important to them.  If the plan they choose does not offer all the benefits they are looking for, be sure they still want that plan. Double check that they know what they are signing up for.  If they do not fully understand the benefits package they may decide later that you did not listen to them and put them into an inferior plan.  Don’t forget there may be other ways for them to have all the coverage they want by adding an affordable ancillary plan.

Please be aware, Medicare beneficiaries often get advice from family or friends saying they have a better plan that is less expensive with more benefits. This may cause them to make a switch.  Be sure you provide the best plan to suite their needs and always be available to answer questions.

Review Outbound Education and Verification calls

Agents need to explain that the client may receive an outbound education and verification (OEV) call from the carrier or the new plan.  Unfortunately some clients disenroll when they get this call because they are not expecting it and get confused.  Make sure they are aware of it and what to expect.

One last thing you can do to avoid the disappointment of a rapid disenrollment

We cannot stress enough that your client needs to understand what they signed up for.  Make sure they understand the plan they chose.  Check back in with them to be sure they do not have any questions and to offer your guidance if they do.  They need to feel comfortable with their choice.  If they are not confident it will only take 1 tv commercial or phone call from a telemarketer to get them to change their plan and you will have a rapid disenrollment.

How they affect the agent

Once a client is considered a rapid disenrollment from a Medicare plan, carriers will recover at least part of the commissions that they paid out.  This is known as a chargeback.

Click here to learn about pro-rated Medicare commissions

Do not go on any shopping sprees until you are sure your clients are happily enrolled in their new plans.

Any rapid disenrollment may bring you to both the carriers attention as well as the attention of CMS.  This is not something you want to happen. Agents with a large number of rapid disenrollments may be investigated for compliance issues.   CMS may need to investigate to be sure you are not enrolling clients into plans under false pretenses just to make a quick buck.  That is why, the client’s best interest has to be your top priority.

Click here to learn about the Medicare Part D changes watch a quick YouTube video

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