An apple a day might help keep the doctor away, but eating all the apples in the world won’t prevent the average person from getting sick from time to time.
To put patients on the mend, a doctor may prescribe an antibiotic, a painkiller, or a more complex pill regimen. However, those who visit the pharmacy hoping to find healing are increasingly coming down with another ailment: sticker shock.
Most seniors live on limited incomes and suffer from at least one chronic condition. Skyrocketing prescription drug prices have made their pills quite bitter to swallow. As a broker, you can help ease their pain by promoting sound prescription drug plans (PDPs). How can you streamline these sales and ensure you set your clients up with the right plan for their budget and needs? Consider these best sales practices.
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1. Be Upfront: Ask Your Clients about Their Prescriptions Right Away
Besides having your clients sign a Scope of Appointment (SOA), one of the first things you should do is get personal and ask for a list of their prescription drugs.
Knowing what prescriptions your clients take is key to finding them the best plan. Why? They’ll want a PDP that makes their current medications more affordable. Wouldn’t you?
You can ask about their prescriptions when you schedule the initial appointment. Getting this information ASAP allows you to work quickly and efficiently which shows your clients you’re proactive.
To simplify the process even further, inform your clients they can get a list of their medications from the pharmacy where they refill their prescriptions. For most large pharmacies, your clients can obtain and email this list to you themselves by registering for an online account.
2. Consider What Type of Plan Works Best with Their Health Coverage
Seniors can obtain prescription drug coverage through either stand-alone PDPs or Medicare Advantage Prescription Drug (MAPD) plans. Your clients’ current or desired form of major medical coverage determines which type of plan they may choose.
If your clients have, or will enroll in, Original Medicare, they can select a stand-alone PDP. Conversely, if your clients desire to enroll in a Medicare Advantage plan, they can enroll in an MAPD plan if one is available. A small number of counties in a few states do not offer an MAPD plan. In these counties, individuals can enroll in a Medicare Advantage plan without prescription drug coverage and a stand-alone PDP.
An important note: If your clients have an MAPD plan but plan to enroll in a stand-alone PDP, make sure they know they’ll be disenrolled from their current plan and enrolled in Original Medicare.
3. Find Out If They Qualify for Additional Help
According to the Centers for Medicare and Medicaid Services, over 2 million Medicare beneficiaries who aren’t enrolled in the Extra Help program may qualify for it.
Extra Help is a government program that can assist your eligible clients in paying the copays, premiums, and deductibles of their PDPs. To be eligible, your clients’ incomes and assets must be below certain levels determined by their state. Those who have full Medicaid coverage, membership in a Medicare Savings Program, or Supplemental Security Income benefits automatically qualify for the program.
Further, your clients who don’t qualify for Extra Help may qualify for a state pharmaceutical assistance program (SPAP). SPAPs can pay for your clients’ Part D coverage entirely or at least lower the cost of their prescription drugs. Their availability and eligibility requirements can be found on Medicare.gov and vary by state.
Programs like these can save your clients thousands of dollars on their prescriptions annually. More notably, they can put your clients’ medications within reach. Because your clients’ financial circumstances can change at any time, it’s important that they contact you if their income or resources decline. Beneficiaries who become newly eligible for Medicaid or Extra Help qualify for a Special Enrollment Period to enroll in a new plan.
4. Use the Medicare Plan Finder to Compare Plans
Once you’ve determined if your clients qualify for additional help, you can get to the core of your work: finding the right PDPs for them. Performing a simple search using the Medicare Plan Finder online tool is a great way to compare options.
As you’re searching, your top priority should be finding PDPs that work with your clients’ medicinal needs. Examine plans’ copays, premiums, deductibles, and network restrictions next. If a client is unwilling to try less expensive drugs first, make sure you’re looking at plans that don’t require step therapy. Additionally, check if plans offer coverage in the “donut hole” and if they work with programs that can offer your clients help with paying for prescriptions.
When it’s time for you to help your clients make their final decision, provide wise recommendations. If they take high-cost prescription drugs, recommend plans that offer coverage for them in the gap stage. Do they take several generic drugs? Suggest plans with low copayments. Don’t have many prescription drugs? Advise they go with a low-premium plan. You’re the expert. Show your clients you know your stuff.
5. Make Sure Your Clients Understand Their New PDP
Insurance is one thing almost everybody has, yet only a select group of people understand it. A 2016 study by PolicyGenius and Radius Global Research found only 50 percent of the Americans they surveyed could correctly define “deductible,” only 42 percent could correctly define “out-of-pocket maximum,” and only 22 percent could correctly define “coinsurance.”
Teaching your clients what basic health insurance terms like these mean is a great way to set yourself apart from your competition and add value to your services. Making certain your clients know how much they will pay for their prescriptions now, after they hit the coverage gap, and after they reach out-of-pocket limit is also a good move. Doing so can build your credibility and your clients’ trust in you.
6. Let Them Know Other Ways They Can Save
Another way to score some more brownie points and help lock in your role as your clients’ top advisor is to inform your clients of other ways they can reduce their out-of-pocket expenses.
Oftentimes, your clients can spend less on their prescriptions by switching to generic or brand-preferred drugs. Ask them if they’re aware of that. Additionally, check to see if your clients can save money by utilizing their plan’s in-network, preferred pharmacies or mail-order pharmacies, and let them know if they can. Even the pharmaceutical companies that produce your clients’ drugs may offer assistance programs to help pay for them. See if your clients qualify for one or more of these programs at Medicare.gov/pharmaceutical-assistance-program.
Finally, confirm your clients know they have a right to ask their plan to cover a prescription drug. Their prescriber can ask their plan for an exemption if a drug in a lower tier does not exist or won’t work for them. Providing all this information to your clients will show them you truly have their best interests in mind.
7. Encourage Your Clients to Reevaluate Their Plan Every Year
Though seniors can change their PDP every year, research shows few review and consider switching plans during the Annual Enrollment Period (AEP). The Kaiser Family Foundation found that an average of 87 percent of Part D enrollees did not switch plans during any of the four AEPs between 2006 and 2010. However, when averaged over the four AEPs, nearly half (46 percent) of those who changed plans had premiums that were at least 5 percent lower the following year.
So lastly, at your final appointments with clients, stress to them the importance of reevaluating their PDPs during AEP. What was their best option one year, may not be the next. Plans can change their premiums, copays, deductibles, formularies, network, and preferred pharmacies. Additionally, your clients could become newly eligible for additional help.
Before you leave any appointment, express to your clients that you’re more than happy to help them shop around and ensure they know how to get in touch with you in the future. By tackling this topic, you’re not only giving them sound advice, but you’re also securing their future business.
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PDPs are a natural cross-sell with Medicare Supplements and Medicare Advantage plans. Those who employ these best practices when selling them will not only maximize their time, but also their production and profits.
A modified version of this article was previously published in the August 2017 issue of California Broker Magazine.