5 Real-Life Medicare Sales Scenarios & How to Handle Them

You’ve got a call from a client or prospect. (Yay!) When you get together to meet with them and hear their situation… well, it’s a doozy. You instantly wish you hadn’t picked up the phone, but you suck it up, smile, and say of course you’ll help. Now what?

All Medicare sales opportunities are unique — some just a little more so than others. We want to help you be better able to handle whatever life — or that client with several major medical conditions and a long list of prescriptions — throws at you. That’s why, today, we’re covering how to troubleshoot some Medicare sales problems you may encounter out in the field! Let’s get started.

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1. Client Missed Medicare Part B Sign-Up Deadline

Scenario: I wrote a client into a Medicare Supplement with an effective date for the next month. He was supposed to sign up for Part B with the same effective date, but he forgot. It’s been a little over a year since he lost his employer coverage and should have enrolled in Part B. Is he out of luck?

How to Help: First, check if your client is eligible for a Special Enrollment Period. If he isn’t, have him call 1-800-Medicare and ask for an exception. CMS may be able to get him on Part B and may even waive the late enrollment penalty. If this doesn’t work, it’s likely your client will have to wait until the next General Enrollment Period to sign up for Part B. In that case, the Med Supp app (and its commission) will be rejected until your client’s eligible to enroll. At future appointments, be sure to verify clients have Medicare Part B before writing an application or try to reach out to the client a few days before their deadline to remind them they have to sign up.

Do your clients think they’ll be automatically enrolled in Medicare? Let them know what to expect

2. Client Needs Hip Surgery, Wants a Med Supp

Scenario: I have a client who needs hip surgery. He’s currently enrolled in a Medicare Advantage Prescription Drug plan and wants to switch to a Med Supp. When’s the best time to write him into a plan?

How to Help: Was your client told by his doctor that he’d need this surgery? If so, he probably won’t be able to pass underwriting into a Med Supp until after his surgery (and possibly any therapy he needs as a result of it). Before telling him he may have to wait, you could check if he has a guaranteed issue right. Guaranteed issue rights vary by state, but here’s a list of the federal ones.

Not sure if a client will have to pass underwriting? Check out A Comprehensive Guide to Medicare Supplement Underwriting for an in-depth look!

3. Client Needs Extra Help Paying for Prescriptions

Scenario: I met with a woman who just aged into Medicare and takes several medications costing thousands of dollars monthly. She was enrolled in Medicare Parts A and B and was auto-enrolled in a prescription drug plan because she applied for and was granted Extra Help. She’d like to start taking her Social Security benefit in order to afford a Med Supp, which she could use; however, this could cause her to lose her Extra Help eligibility. What should I recommend she do?

How to help: Does your client qualify for Medicaid? How about a Dual Eligible Special Needs Plan? You could help your client set up and prepare for an appointment with a Medicaid caseworker. Additionally, you could check if she’s eligible for a State Pharmaceutical Assistance Program or any drug manufacturer rebates. There are also a few simpler ways to save on drug costs that your client might not be aware of. Make sure she understands the value of buying generic vs. brand-name prescriptions and using in-network or mail-order pharmacies.

Is your client using the right pharmacy for their budget? Learn how preferred pharmacies can save them money

4. Simple Medicare Sales Pitch Needed

Scenario: I sell all the major MA, Med Supp, and PDP plans. During my presentation, I try to educate clients about all their Medicare options, but by the time I get through my spiel, they seem too overwhelmed to make a decision that day. What can I do to streamline my Medicare sales presentation?

How to Help: If your clients seem overwhelmed by all the facts, you may be over-educating them. Try to simplify the decision-making process for them. Make your pitch more like a casual conversation, rather than presentation. Focus on finding out their coverage needs and what they value in a plan, not the options themselves. To do this, you’ll have to ask questions, especially simple ones like, “Are you open to seeing a new doctor if it means you could save money?” When ready, briefly tell them about the types of coverage they can get and which type you think best fits their preferences and why.

Want to improve your sales pitch out in the field? Make sure you know these four tips

5. Agent Error on Medicare Application

Scenario: I mistakenly checked the wrong box on an application and enrolled a client into the wrong MA plan. What should I do?

How to Help: Everybody makes mistakes. Nobody’s perfect. If you learn you made an error, the best thing to do is to take responsibility for it. Let the beneficiary know what happened, apologize for your mistake, and let them know that you’ll do everything you can to make things right for them. Call or email the carrier to let them know about the error. They may have a Corrections form you can fill out. Depending on the carrier, they may even change the enrollment to the right plan retroactively.

Want to try to avoid making mistakes like this again? Check out our tips to submitting error-free applications

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Medicare sales aren’t always going to be easy. You’ll probably get your fair (maybe unfair) share of whoppers, but you can handle them. We believe in you. You’ve gone through Medicare sales training, completed certifications, and have already helped numerous people, remember? And if you ever feel like you’ve bitten off more than you can chew or just want a second option on a tough case, we’re always just a phone call or message away!

What’s a Medicare sales dilemma you’ve encountered? How’d you manage to help the client? Let us know in the comments!

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