Real Life Medicare Sales Examples

Real Life Medicare Sales Examples

As Medicare agents, we have access to a lot of training.  In person training with carriers and uplines, annual carrier certifications, AHIP and a number of other options.  The majority of trainings have great content but tend to be generic in nature.  They give us information on topics such as benefits, election periods, marketing rules and numerous other areas of Medicare.  They usually do not get specific to the real scenarios we run into, however.  The post below reviews the most common real life Medicare sales examples and how to handle them.

Note:  The most important part of all the following scenarios is to ask questions to understand the prospects specific situation.   Only when we understand the details about the person’s specific situation can we make solid recommendations. The reality is, many agents do not ask questions and just as many do not listen to the answers when they do ask.  Listening to the prospects concerns can make the sale for you.

Are you new to Medicare sales?  Watch this video for the basics on a Medicare sales appointment

Turning 65 prospect:   Example 1

The first of the real-life Medicare sales examples is the best one for agents.  When someone turns 65 and new to Medicare, we know the full CMS max allowable commission will be paid and the case will not be pro-rated.  A T-65 sale is really more of an education than a sale.  The person turning 65 usually does not know all the rules with Original Medicare.  They also may not be sure about the differences between a Supplement and Advantage plan.  Here is how to handle a T-65 meeting.

Information about Original Medicare

After you have asked some basic questions to understand the situation you should explain Original Medicare to the prospect.  The following points should be made:

• When Medicare A and B will start for them  (Remember those with a B-day on the first of the month will have a start date of the previous month)
• They are only auto enrolled if they are already receiving Social Security payments
  • If not receiving SS payments, give them the link to apply online
• The cost for Medicare Part B and how it will be billed.  It can either be taken out of the Social Security check or billed quarterly if not receiving SS payments.  Remember to tell them about “Medicare Easy Pay“
• Warn them about IRMAA for part B and D and how it works
• Explain the benefits of A and B and point out what they do not cover
• Tell them you will explain the two most commonly used ways people insure themselves to cover the cost shares not covered by Medicare

Information about Medicare Advantage and Medicare supplements

• Start with the supplement
• Explain that they will have a total of 3 plans and 3 premiums
• Showing this to them visually can help
• Give them the pro’s and cons of going with a supplement and drug plan
• Give them the pro’s and cons of a Medicare advantage plan
• Get their thoughts on which type of plan would be better for them
• Get a list of doctors (In case they go advantage) and Medications (Advantage or supplement and part D)

Information about enrollment periods and annual follow up

• Explain to them when they need to submit applications or enroll online
• Let them know you will call them every year during the AEP to review with them and see if there are better coverage options available for the next year

Real life Medicare sales examples:  Over 65 or turning 65 and working: Example 2

Know the Part B enrollment rules

When it comes to those still working past Medicare age, the agent needs to know the Part B rules for both valid waivers and enrollment.

Watch a YouTube video on Medicare for people working

• Who can delay enrolling in Medicare Part B at 65 or older?
  • There are 3 criteria that need to be met to waive Medicare Part B
    • The Medicare beneficiary must work for a company with 20 or more employees
    • They must be actively working or getting coverage through an actively working spouse
    • They must either have coverage through their employer or coverage through the actively working spouse’s employer
      • They cannot be working and getting coverage through a different means such as a former employer, cobra or an individual plan
      • Reminder:  VA coverage and COBRA are NOT valid reasons to waive Medicare Part B

Delayed Medicare Part B enrollment

• It is important to know how members enroll in Medicare Part B after age 65
  • If the member no longer meets the criteria to delay part B they will have an election when the criteria are no longer being met
    • An example would be someone who is working and getting coverage through work but decides to retire or loses employment
    • Loss of employment would trigger the need to enroll in Medicare part B
    • The member will need get an employment verification from the employer in order to enroll in Medicare Part B on a delayed basis
    • If the special enrollment for Part B is missed, the member must enroll in Medicare Part B during the general election period (GEP).  The GEP runs from January through March.

Stay on the employer plan or buy Medicare Part B and move to a stand-alone plan?

Although some people may be working and getting coverage through work, it may still make sense for them to enroll in Medicare.  The agent needs to look at the amount the employee is paying for coverage and the benefits they are getting.   They can then compare that to the additional cost of adding Medicare Part B and the benefits they would get from an Advantage or Medicare supplement plan.  The working member does not have to stay on the employer coverage if the math and benefits do not make sense.

Keep in mind someone working for an employer of less than 20 employees needs to sign up for Medicare Part B even if they are working and getting coverage through work.   They will need to pay for Medicare B regardless so it often makes sense to move this person to a Medicare Advantage or supplement plan.

Working with someone that is potentially dual eligible:  Example number 3

The 3rd real life Medicare sales example is working with dual prospects. Extra benefits have become a very important part of dual sales over the last few years.  Dual members are looking for plans that will provide the highest dental, vision, OTC, Flex and grocery benefits.  Other benefits such as utility cards have also become more important.  Other members look for transportation benefits.  The most important aspect for an agent is to ask questions and figure out which of those benefits are most valuable to potential members.  Once that is determined, the agent can quickly quote and compare the various dual benefits on Connecture, Sunfire or MyMedicareBot to find the plan that best meets the clients needs.

Figuring out which level of “dual” you are working with

Dual prospects often do not know the level of help they receive.  A number of dual plans only accept clients receiving a certain level of help.  Some plans accept full dual only while others will take full dual and/or QMB level.  While both full and partial duals (QMB) receive help with medications and Medical copays, the QMB only dual does not receive extra benefits such as dental and vision. As a result, the extra benefits of a dual plan can be more appealing to a QMB only.  Regardless, the agent needs to know the level of Medicaid the client currently has.  Enrollment systems such as Sunfire give the agent access to a limited version of Marx which allows them to look up the status.  Those without access to Sunfire can access the information through carrier platforms such as UHC Jarvis.

In the case when such systems cannot be accessed, agents can ask questions to help determine the level of coverage.  Asking the prospects if they pay copays when they see doctors can eliminate lower levels of help such as SLMB or ALMB (States that have ALMB) and SPAP programs that only help with medications.   If the prospects pays for medical copays but has limited medication copays and/or does not pay their Medicare part B premium, they likely are in a drug help only program.   If they do not pay medical copays but you are not able to determine full dual vs. QMB, it may be wise to suggest a dual plan that accepts both populations.

Final thoughts working with duals

In conclusion, the agent needs to identify the level of coverage, ask which extra benefits are most important to the prospects and then quickly find the plan that offers the richest of those specific benefits.  Lastly, keeping the dual on the books can always be a challenge.  As a result, it is important to stay in contact with dual populations and also encourage them to sign up for the federal do not call list.  Dual eligible populations are at a much higher risk of unknowingly switching plans over the phone due to the high volume of Medicare type calls they receive.  Being on the DNC can help reduce those calls.

Real life Medicare sales example number 4:  Trying out a Medicare Advantage plan

As agents, we often run into clients that have a Medicare supplement plan.   Often times they are familiar with Medicare Advantage plans and would like to try one but have never done it.  The main fear they have is not being able to get back into the Medicare supplement if they do not like the advantage plan.  Agents that understand the rules of an all time GI state, (NY, CT, MA, ME) and the Medicare Trial Right, can get more advantage sales.

All time GI states

It is much easier to have a Medicare supplement client try an advantage plan in one of the 4 all time GI states.  Given that underwriting is never allowed on Medicare supplements in these states, the member is able to try an advantage plan without the risk of being locked out of a supplement in the future.  As a result, the member can try the Medicare advantage plan and will always have the ability to change back to a supplement during the AEP or OEP if needed.

Medicare Trial Right

The Medicare Trial Right can be utilized in all time GI states and underwritten states when it comes to trying out an advantage plan.  The trial right allows the Medicare supplement member to try an Advantage plan with the GI right to move back to a supplement if they decide the advantage plan is not for them. It is very important for the agent to fully understand Trial Right rules when utilizing this strategy. When a Trial Right is in place, the member has 12 months to move back to a supplement.  During this time, they can make the move back on the first of any month during the 12-month period.

Trial Right number 1  

The member enrolled in an advantage plan when they became eligible at the age of 65.  If the member enrolled in Medicare at age 65 and their first plan was an advantage plan during their IEP, they have a 12-month Trial Right.  The Trial Right is only for those that enrolled at age 65.  There is no Trial Right for those that enrolled in Medicare after their turning 65 IEP.

Trial Right number 2

The second Trial Right is for those that have had nothing other than a Medicare supplement since they have been on Medicare A and B. (Regardless of their age when they enrolled in Medicare A and B)  If that member decides to try a Medicare Advantage plan for the first time, they will have a 12 month Trial Right.  This gives them the ability to try the Advantage plan for up to 12 months with the ability to move back to a Medicare supplement without underwriting during this time.

Real Life Medicare sales examples number 5: Prospects that are happy with their current plan

Agents will often talk to a prospect that is happy with their current plan.  Sometimes the agent can ask questions to determine if they are truly happy with it. Maybe there are plans that would fit them better they don’t know about or they may just be resistant to change.  If that is the situation, a good agent may be able to find a better option for them.  However, sometimes they actually are on the plan that has the best benefits for them.  When this happens, the agent will often move on to the next prospects without following up with the prospect again.  Many potential sales are lost when this happens.

Medicare supplement rate increases and Advantage plan benefit changes

The reality is that Medicare supplement rates increase, and Medicare Advantage plans can have poor renewals.  An Advantage plan that looked appealing one year may not look as good the next.  This may be due to an increase in copays, lowering of extra benefits or a new plan coming to the market with notably better benefits.

Had the agent kept the prospects contact information and scheduled a follow up during AEP, they may be able to write the prospect a new plan.  It is usually easier to follow up with such a prospect because a relationship has already been established.  On the other hand, if a follow up does not happen, the opportunity is lost.  It is important to schedule follow up AEP calls with past appointments or  with clients that you did not sell to.  This will help to build the sales pipeline and can be more time efficient than closing a prospect you have not established a relationship with.

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