Search
Close this search box.
National Contracting Center
Search
Close this search box.

How To Do A Medicare Advantage Needs Analysis

Medicare Needs Analysis

Medicare Needs Analysis – Use This Form

Read below to find out how to conduct a Medicare Advantage Needs Analysis, and make sure you download our convenient needs assessment form to make the process easier. The form is available both in printable format and as a downloadable pdf.

You can’t find the best coverage for your Medicare Advantage clients without getting to know their needs. What medications do they take? What’s their health history like? Understanding these details is your first step in giving excellent service and being the most-referred agent in town.

Want to step up your sales game? Ask the right questions during your next Medicare needs analysis.

1. “Has anyone explained your Medicare options lately?”

This is the most critical question you can ask a client. 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 cover and how other plans function. Most don’t, so be the one agent who takes the time to help them navigate Medicare. 

2. “Do you want any prescriptions checked?”

(Note that an agent cannot ask any Medicare beneficiary, “what prescriptions do you take?”) Each Medicare Advantage plan that includes drug coverage has a set formulary of generic and brand names that the plan agrees to cover. You may need to research prescriptions to see if either generic versions or a similar drug is covered in the plan formulary. If not, clients will have to pay out-of-pocket for 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. The difference between a $20 and $40 copay can make a big difference if your client goes to a primary care physician and a specialist ten times a month. For example, a person receiving physical therapy might see a specialist three times a week and pay the specialist copay each time.

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.

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 Medicare Advantage carriers may have a special needs plan that will cover chronic conditions like ESRD. As long as the client doesn’t have ESRD, they can’t be denied coverage for pre-existing conditions.

6. “Do you know anyone who has been 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 most significant relief to your client and keep costs as low as possible.

7. “Do you live part-time in another state or travel frequently?”

Medicare Advantage plans usually have a local/regional provider network designed with special cost controlling practices. All visits to out-of-network providers may not be covered, or clients will pay higher rates. You must check each plan’s benefits to see travel and residency coverage restrictions. 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?”

Get insight into what your client is looking for in a Medicare Advantage plan and perks. If the client loves gym membership perks, you can look into plans that reward healthy 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?”

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.

10. “Do you currently receive health coverage through a 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.
 
Want to talk more about how to conduct a medicare needs analysis? Call 800-695-0280 to talk to a Marketing Specialist today.

Related Resources

Share This

Latest Posts

Categories

Follow Us

To get alerts like this with news, tools, and information to grow your business, subscribe to our newsletter or RSS feed, or follow us on social media.

pop up circle

Aetna

 

Aetna is an American managed health care company that provides traditional and consumer-directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid insurance and benefit programs1. Aetna is a proud CVS Health company and shares a common purpose with CVS Health: bringing their heart to every moment of your health. Aetna believes that everyone should have a fair and just opportunity to achieve their best health, which is known as health equity. Aetna is committed to improving the environment, addressing health inequalities, investing in people’s health, acting with integrity and protecting against health care fraud and abuse.

Clover Health Certification Requirements for 2024

  • Details refer to certification for Clover Health. AHIP certification must be completed separately.

Clover Health Certification Links, Guides, Phone Numbers, Emails

Clover Health Certification Requirements for 2024

  • Details refer to certification for Clover Health. AHIP certification must be completed separately.

Clover Health Certification Links, Guides, Phone Numbers, Emails

Medicare Sales Training Guide

This comprehensive 64-page guide covers senior insurance sales from all angles, from licensing to sales.

“Medicare 101” details coverage types, benefits, eligibility requirements & more!

WellCare Producer Certification Requirements for 2024

  • Details refer to certification for WellCare. AHIP certification must be completed separately.
  • Passing score is 85%.
  • 3 attempts.

WellCare Certification Links, Guides, Phone Numbers, Emails

WellCare Producer Certification Requirements for 2024

  • Details refer to certification for WellCare. AHIP certification must be completed separately.
  • Passing score is 85%.
  • 3 attempts.

WellCare Certification Links, Guides, Phone Numbers, Emails

Shared Health of MS Producer Certification Requirements for 2024

  • Details refer to certification for Shared Health of MS. AHIP certification must be completed separately.
  • More information coming soon!

Shared Health of MS Producer Certification Requirements for 2024

  • Details refer to certification for Shared Health of MS. AHIP certification must be completed separately.
  • More information coming soon!

Devoted Health Certification Requirements for 2024

  • Details refer to certification for Devoted Health. AHIP certification must be completed separately.

Devoted Health Certification Links, Guides, Contact Info

Devoted Health Certification Requirements for 2024

  • Details refer to certification for Devoted Health. AHIP certification must be completed separately.

Devoted Health Certification Links, Guides, Contact Info

Humana Producer Certification Requirements for 2024

  • Details refer to certification for Humana. AHIP certification must be completed separately.
  • English Cert/Recert is now open.
  • To access this training you will login at www.Humana.com, then click on the “Get Certified/Recertify” button from the Humana Vantage home page.

  • If you have completed the Humana PY23 Certification and are currently certified to sell Humana Medicare products, the deadline will be 5:00 pm Eastern on Thursday, November 30, 2023, to complete the PY24 Recertification.

  • Spanish Cert/Recert will be launching later in the summer. More information coming soon.

Certification Links, Guides, Phone Numbers, Emails

Humana Producer Certification Requirements for 2024

  • Details refer to certification for Humana. AHIP certification must be completed separately.
  • English Cert/Recert is now open.
  • To access this training you will login at www.Humana.com, then click on the “Get Certified/Recertify” button from the Humana Vantage home page.

  • If you have completed the Humana PY23 Certification and are currently certified to sell Humana Medicare products, the deadline will be 5:00 pm Eastern on Thursday, November 30, 2023, to complete the PY24 Recertification.

  • Spanish Cert/Recert will be launching later in the summer. More information coming soon.

Certification Links, Guides, Phone Numbers, Emails

Cigna Medicare Producer Certification Requirements for 2024

  • Details refer to certification for Cigna Medicare. AHIP certification must be completed separately.
  • Passing score is 85%. You have 3 attempts.

Cigna Medicare Certification Links, Guides, Phone Numbers, Emails

Cigna Medicare Producer Certification Requirements for 2024

  • Details refer to certification for Cigna Medicare. AHIP certification must be completed separately.
  • Passing score is 85%. You have 3 attempts.

Cigna Medicare Certification Links, Guides, Phone Numbers, Emails

BlueCross BlueShield of TN Producer Certification Requirements for 2024

  • Details refer to certification for BlueCross BlueShield of TN. AHIP certification must be completed separately.
  • More information coming soon!

BlueCross BlueShield of TN Producer Certification Requirements for 2024

  • Details refer to certification for BlueCross BlueShield of TN. AHIP certification must be completed separately.
  • More information coming soon!

Wellpoint Producer Certification Requirements for 2024

  • Details refer to certification for Wellpoint. AHIP certification must be completed separately.
  • Passing score is 90%.
  • 3 attempts.

Wellpoint Certification Links, Guides, Phone Numbers, Emails

Wellpoint Producer Certification Requirements for 2024

  • Details refer to certification for Wellpoint. AHIP certification must be completed separately.
  • Passing score is 90%.
  • 3 attempts.

Wellpoint Certification Links, Guides, Phone Numbers, Emails

Aetna Producer Certification Requirements for 2024

  • Details refer to certification for Aetna. AHIP certification must be completed separately.
  • The 2024 Individual Medicare Producer Certification for MA, MAPD, PDP and SNP launches on Wednesday, June 28, 2023

          Aetna Medicare will offer two certification options:

  • Aetna Medicare Compliance Training: Certifies producers to sell Aetna only (AHIP alternative)
  • AHIP Medicare Training: Certifies producers to sell for mulitiple carriers, including Aetna. 

 

Aetna Certification Links, Guides, Phone Numbers, Emails

Aetna Producer Certification Requirements for 2024

  • Details refer to certification for Aetna. AHIP certification must be completed separately.
  • The 2024 Individual Medicare Producer Certification for MA, MAPD, PDP and SNP launches on Wednesday, June 28, 2023

          Aetna Medicare will offer two certification options:

  • Aetna Medicare Compliance Training: Certifies producers to sell Aetna only (AHIP alternative)
  • AHIP Medicare Training: Certifies producers to sell for mulitiple carriers, including Aetna. 

Aetna Certification Links, Guides, Phone Numbers, Emails