Medicare Advantage, Real and Comfortable Conversations

Medicare Advantage, Real and Comfortable Conversations

Our previous post discussed how agents can educate themselves to better understand the products they offer and their impact on clients. Now, let’s get into how to speak to clients to assist them and not “sell” them into choosing a plan. 

As you begin the conversation, remember your goal is to listen carefully — not just for what the client needs, but also for what matters most to them personally. While they may have experience with other types of insurance, Medicare is new territory for many, so be prepared to explain it clearly and answer their questions with patience and accuracy.

Those preparing to enroll or reenroll in Medicare usually research the benefits. They appreciate printed or digital side-by-side comparisons. According to research into Medicare buyer personas, women tend to prefer comparison shopping, while men tend to take more time to read the fine print and plan details. 

Don’t engage in Medicare conversations before you obtain the required completed forms. Get the Permission to Contact (PTC) first to initiate a conversation with a beneficiary, followed by a Scope of Appointment (SOA) to schedule and specify the products to be discussed. 

A Needs Analysis, which is required during enrollment, allows you to obtain vital information regarding the client's requirements from their Medicare Advantage plan. To assist you in determining what may be necessary, we have included the following questions to help you cover a Needs Analysis:

• What do you enjoy about your current coverage? Your benefits, doctors, hospitals, costs, or some specific features? 
• What’s one thing about your current coverage you wish were better?
• If you could add one thing to your Medicare plan right now, what would it be?
• Is travel or living elsewhere at times part of your lifestyle?
• Do you currently pay out-of-pocket for expenses such as dental check-ups or eyeglasses?
• Would you be interested in a plan that includes more everyday wellness support?
• Do you feel like you’re spending more out-of-pocket on health care than you’d like?
• Are you currently paying for items such as glasses, hearing aids, or dental work?
• Do you enjoy staying active through fitness classes or using a gym?
• Would things like transportation, meal delivery, or wellness programs be helpful in your day-to-day living?

Some clients will ask, “Can these benefits help me stay healthier?”

To be clear, you are not a medical professional. You do not know their day-to-day health. CMS strictly prohibits making statements that guarantee or imply improved health outcomes from MA plan benefits, including supplemental benefits such as dental, vision, or fitness programs. 

Plans can say what is covered. It is imperative to avoid language that implies a cause-and-effect relationship. Instead, say, “Many people find these helpful in maintaining their routine care, but you have to look at what’s right for you since everyone’s health needs are different.”

Before you help someone enroll in Medicare Advantage, you are required to discuss major areas that affect their choice. CMS requires this so that clients understand what is offered and can then make an informed decision. 

The goal is for clients to choose a plan based on their needs, not merely selecting a plan based on a low premium or another attractive feature, but one that actually covers their medical needs. 

CMS requires agents to discuss the following required topics, so you need to ask about and explain:

• Primary Care Providers and Specialists: Are they keeping their current doctors? If so, are they in the plan’s network? If they are changing doctors, ensure they are in network.
• Prescription Drug Coverage: Are their prescriptions covered? What will they cost?
• Costs of Health Care Services: Explain the copays, deductibles, and coinsurance.
• Discuss the costs for medical services, not just premiums. They need to understand their financial responsibilities.
• Premiums: Discuss the actual monthly premium and how it is paid/collected.
• Benefits: Explain what services and benefits the plan offers, including dental, vision, hearing, fitness, transportation, etc.
• Specific Health Care Needs: Discuss the beneficiary’s unique health care needs and how the plan options address them.

Source: CFR 422.2274 Agent, broker, and other third-party requirements

Comfortable Conversations

Finally, let’s delve into real talk – conversations that keep you on track with presenting education about Medicare and Medicare Advantage products. Here are a few ways to explain Medicare Advantage to your clients.

A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage.

Medicare Advantage Plans, also known as Part C or MA Plans, are Medicare-approved health plans.

Most Medicare Advantage plans include Medicare Part D, also known as Medicare drug coverage.

With a Medicare Advantage Plan, you may have coverage for things Original Medicare doesn’t cover, like fitness programs, some vision, hearing, and dental services – like routine checkups or cleanings.

Some Medicare Advantage plans may cover additional benefits, such as transportation to doctor visits or over-the-counter medications that Part D doesn’t cover. You can review the plan before joining to determine what benefits it offers, the associated costs, and any applicable limitations.

Depending on where you live, some Medicare Advantage plans have $0 monthly premiums and also offer prescription drug coverage and extra benefits.

If you don’t have dental, vision, and hearing, there are Medicare Advantage products that you can access to get that coverage.

With Medicare Advantage, you’re not locked in for life. Just like other insurances, you can review and switch plans during the Annual Enrollment Period. 

Final Words

When clients understand Medicare Advantage and the benefits it offers, the process is not about selling. In fact, CMS’s official stance is that agents should not “sell” MA plans, but rather educate and explain the plan so that beneficiaries can make informed, unbiased decisions.

Agents must not pressure or steer beneficiaries toward any specific plan or type of plan. They are warned not to mislead or confuse beneficiaries, make statements that could pressure enrollees, or use sales-oriented language or high-pressure tactics. 

Leading up to the Annual Enrollment Period (AEP), agents can experience the most success when they focus on contracting, carriers, certification, technology, compliance, and learning the carriers’ new products.  

When you contract with Messer as an FMO, you get the kind of help you need to reach AEP, prepared to quote and enroll clients. If you’re ready to take the leap with an FMO, reach out to Messer.  We have your back!

Sources for this and previous blog:

MedPAC and Kaiser Family Foundation reports indicate MA enrollees are generally healthier and more likely to report good or excellent health.

Harvard and Inovalon Research published on November 9, 2023, found that MA beneficiaries have fewer hospital readmissions, fewer preventable hospitalizations, and lower rates of high-risk medication use. 

Centers for Medicare & Medicaid Services (CMS). Some questions are exact verbiage from CMS 

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