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How To Do A Medicare Advantage Needs Analysis

Updated March 31, 2020

In light of the current coronavirus outbreak, we’ve updated our Medicare Needs Assessment Form, which is now available in both printable and fillable PDF formats.

We wanted to refresh new and veteran agents who use a Medicare Advantage needs analysis for clients. Do you really need to do a Medicare needs analysis? Yes. Asking these questions helps provide a greater context of the senior’s medical history and saves your clients money and headaches.

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

This is the most important 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 is not allowed to 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 10 times a month. For example, a person receiving physical therapy might see a specialist three times a week and pay the specialist co-pay 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 greatest 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 providers who are out-of-network may not be covered, or clients will pay higher rates. It is essential you 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 client loves gym membership perks then 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.
Hopefully, our Medicare needs analysis is a helpful guide before we embark on the busy AEP season. For agents new to Medicare Advantage, please feel free to call for more information about a Medicare needs analysis.

Confidential Needs Assessment Form

Make your Medicare Advantage Needs Analysis even easier. NCC’s exclusive needs assessment form puts all of the information you need into one document.

  • Medicare coverage
  • Life insurance coverage
  • Income and Assets
  • Long term care assessment
  • Referrals

Download NCC’s free needs assessment form today and start writing more Medicare Advantage business. We’ll also give you two extra downloads – “3 Simple Steps to Handling Objections” and “How to Answer Objections Over the Phone”

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