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.
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.