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How To Do A Medicare Advantage Needs Analysis

As Annual Enrollment Period (AEP) is about to take off we wanted to refresh new and veteran agents who undergo Medicare Advantage needs analysis for clients. Do I really need to do a Medicare needs analysis? Yes. Asking these questions help provide a greater context of the senior’s medical history and thus you can help select a Medicare Advantage plan that fits their needs. It’s crucial that you take time to listen and understand your client’s current needs and future goals with their Medicare coverage. Asking these simple questions can end up saving your clients money and headaches.

1. "What do you know about Medicare?"

This is the most important question you can ask a client. Does your client understand how Medicare works and the selection of Medicare coverage options available?  It’s your duty as their insurance expert to educate them on Medicare. They need to understand what Part A, Part B and Part D covers and how other plans function. Ultimately, clients need to make a Medicare decision based on knowledge and confidence.

2. "What prescriptions do you take?"

Each Medicare Advantage plan that includes drug coverage has a set formulary that is accepted meaning the plan formulary has a list of generic and brand names that the plan agrees to cover. You may need to research prescriptions to see if either generic versions or similar drug is covered in the plan formulary. If not clients will have to pay out-of-pocket for that any prescriptions not covered.

3. "How often do you go to the doctor or see a specialist?"

Most Medicare Advantage plans require a small copayment for visits after the Part B deductible is met. If your client goes to a primary care physician, and a specialist 10 times a month these costs can add up.  The difference between a $20 and $40 copay can make a big difference with repeated visits during the year.

4. "Do you have a particular doctor, hospital or pharmacy that you want to use?"

If you are enrolling a client in a Medicare Advantage Plan, the carrier has developed a network of providers which results in cost savings for beneficiaries.  Policyholders could end up paying more for their medical care and prescriptions if you don’t double check if their preferences are in network. A simple procedure covered in network could end up being thousands of dollars out-of-network.

5. "Do you have End Stage Renal Disease or any other chronic conditions?"

If a client has ESRD they cannot enroll in most Medicare Advantage plans. However, some private Medicare Advantage carriers may have a special needs plan that will cover chronic conditions like ESRD. Please check carrier product plans to see if a Special Needs Plan is available. 

6. "Do you live in an assisted living, long-term care or skilled nursing facility?"

Medicare has limits on the number of days it covers for care in a nursing home facility. You will need to research which Medicare Advantage plan can provide the greatest relief to your client and keep costs as low as possible.

7. "Do you live part-time in another state?"

Medicare Advantage plans usually have a local/regional provider network designed with special cost controlling practices. All visits to providers who are out-of-network may not be covered and will clients will pay higher rates. It is essential you check each plans’ benefits to see travel and residency rate changes.  No matter what Medicare Advantage plan you have, if clients require emergency or urgent care the plan MUST cover it.

8. "What do you like about your current Medicare plan (if applicable)?"

Get insight into what your client is looking for in a Medicare Advantage plan and perks. If client loves gym membership perks then you can look into plans that reward health lifestyles with gym memberships. It lets clients know you are trying to find plans that fit their needs and future expectations.

9. "What don’t you like about your current Medicare plan (if applicable)?"

See if there is an area of a Medicare plan that you can improve on. Perhaps their current plan doesn’t cover a preferred specialist or service your client would visit. Again, it helps you get as much background information about how your client uses their current benefits, and plan services. However, it can highlight what benefits they may not be aware of. Use the opportunity to educate them on all of the resources that maybe available to them under plans in their region.

10. "Do you currently receive health coverage through former employer or organization?"

Some retiree plans work in tandem with Medicare to cover clients’ health needs, and some lapse when Medicare eligibility arises. Clients need to speak with the benefits coordinator to see how a Medicare Advantage plan would affect their retiree coverage and if there will be any gaps.
Hopefully, our Medicare needs analysis is a helpful guide before we embark on the busy AEP season. Are there questions you always ask when meeting a client? Let us know and we can add it to our list! For agents new to Medicare Advantage, please feel free to call for more information about a Medicare needs analysis.

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About National Contracting Center

NCC is a leading senior insurance marketing firm (FMO) specializing in Medicare Advantage, Medicare Supplements, and Final Expense products for independent agents. NCC partners with you to provide support, training, and concierge service for all your insurance needs.

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