A fact finder for Medicare clients helps agents gather the information they need to provide their prospective clients personalized coverage options. Understanding a client’s healthcare needs, financial situation, and preferences is essential to find the best plan options.
A well designed fact finder provides insight for other products your client may need in the future. Keeping the fact finder in your client’s file allows you to use it for future reference.
What is a fact finder
A fact finder is a questionnaire or checklist agents use to collect important client information before making plan recommendations. It helps ensure the client receives a plan that aligns with their healthcare needs, prescription drug requirements, and budget. Many agents design their own fact finders based on their product offerings. We have included some sample fact finders below:
Download an example of a fact finder
CMS Medicare fact finder sheet for T-65 individuals.
Personal Life & DI Insurance fact finder
Why use a fact finder
Personalized Recommendations: Understanding the client’s medical history, prescriptions, and preferred providers allows agents to suggest plans that fit the client’s needs and minimize out-of-pocket costs.
Compliance and Documentation: A properly documented fact finder can help demonstrate that the agent followed CMS regulations and provided unbiased recommendations.
Client Trust and Retention: Gathering detailed information shows professionalism, making clients feel valued and confident in their choices.
Efficiency in the Sales Process: A fact finder streamlines the appointment, making the plan selection process smoother.
Components of a fact finder
To create a comprehensive Medicare fact finder, agents should include the following:
Client demographics
- Full Name
- Date of Birth
- Address
- Phone Number & Email
- Medicare Beneficiary Identifier (MBI)
Current Medicare coverage
- Does the client have Original Medicare (Part A & B)?
- What type of coverage do they currently have a Medicare Advantage or Medicare Supplement plan?
- Do they have a standalone Part D plan?
- Any employer or retiree coverage?
- Do they qualify for Medicaid or a Medicare Savings Program?
Healthcare needs
- List of current doctors and specialists
- Preferred hospitals and pharmacies
- Frequency of doctor visits
- Any planned surgeries or treatments
- Any chronic conditions (diabetes, heart disease, etc.)
Prescription drug information
- Current medications, including name, dosage, and frequency
- Preferred pharmacy (retail or mail-order)
- Any high-cost prescriptions requiring special coverage
Click here for an example of a Part D fact finder
Financial considerations
- Monthly budget for healthcare costs
- Concerns about out-of-pocket expenses
- Eligibility for Extra Help (Low-Income Subsidy) or state assistance programs
Additional benefits and preferences
- Interest in dental, vision, or hearing coverage
- Need for transportation, OTC or fitness benefits
- Preference for HMOs vs. PPOs
Decision-making preferences
- Is the client the primary decision-maker?
- Do they have a power of attorney or family member assisting with decisions?
- Preferred method of communication (phone, email, in-person)
Using the fact finder
After you introduce yourself to a new client and they feel comfortable speaking with you, you can complete a basic needs analysis. Take notes about their current plan; what they like and what they would change if possible. Find out what is most important to them and when they need the coverage.
- Keep it Conversational: Don’t make it feel like an interrogation. Use open-ended questions to gather insights.
- Explain the Purpose: Let clients know that this information helps tailor their plan selection.
- Ensure Accuracy: Confirm key details like medications and provider networks to prevent surprises later.
- Document Thoroughly: Keep a copy for future reference.
Do you need a Scope – click here
Ready to join a team that supports their agents- click here for online contract
A Medicare fact finder is an indispensable tool for agents, helping ensure clients receive the coverage best suited to their needs. By using a structured fact finder, agents can enhance efficiency, improve compliance, and build stronger relationships with their clients.
It is a good idea to repeat/review their biggest concerns and make sure you are clear on exactly what they are looking for in a health care plan. Make sure they understand you are there to show them their best options, but the decision is theirs.
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