Every Medicare beneficiary needs credible prescription drug coverage, and most want to avoid late enrollment penalties. If you’re offering Medicare Advantage-only plans (such as Private Fee-for-Service or Medicare MSA) or Medigap plans, prescription drug insurance is an excellent cross-selling opportunity. Here’s how to make it work!
For clients interested in Medicare Advantage, they can enroll in a Medicare Advantage Prescription Drug (MAPD) plan if one is available. On the other hand, clients with Original Medicare—possibly paired with a Medicare Supplement plan—can obtain prescription drug coverage through a stand-alone Prescription Drug Plan (PDP), also known as Medicare Part D.
In some counties across a few states, MAPD plans may not be available. In these areas, individuals can enroll in a Medicare Advantage plan without drug coverage (such as a PFFS or Medicare MSA plan) alongside a stand-alone PDP.
Here, we’ve outlined seven best practices for selling PDPs. By following these steps, you can help clients find the right plan for their budget and needs, increase your commissions, and foster client loyalty!
Note: If clients enrolled in an MAPD plan choose to switch to a stand-alone drug plan, ensure they understand that this change will disenroll them from their current plan and enroll them in Original Medicare (Parts A and B).
1. Request a List of Your Clients’ Prescriptions Immediately
Once your clients have signed a Scope of Appointment (SOA), one of your first steps should be to request a list of their prescription medications. Knowing their current prescriptions—especially any high-cost drugs—is essential for finding a plan with a formulary that covers their medications. After all, your goal is to match them with a plan that makes their prescriptions as affordable as possible, as different plans cover specific medications in various ways.
Does manually entering all your clients’ prescriptions into a CRM sound time-consuming?
Streamline the process with BlazeSync and RetireFlo, powerful features in platforms like Sunfire and Connecture. These consumer-friendly tools let Medicare-eligible clients learn, explore, compare, and enroll in Medicare plans—and empower them to enter their prescriptions directly into their profile. This approach saves you valuable time, reduces errors, and enhances accuracy. Contact us to learn more about how Connect4Insurance platforms can make your work easier!
2. Determine Eligibility for Financial Assistance
Government and state programs can significantly reduce the cost of prescription drugs and coverage for eligible clients. For example, the Medicare Extra Help program (also known as the Part D Low-Income Subsidy) helps qualifying beneficiaries cover copays, premiums, and deductibles associated with their Prescription Drug Plans (PDPs).
To qualify, clients must meet income and asset thresholds, which vary by state. Clients with full Medicaid coverage, enrollment in a Medicare Savings Program, or Supplemental Security Income benefits are automatically eligible.
If Extra Help isn’t an option, clients might still qualify for a State Pharmaceutical Assistance Program (SPAP), which can fully or partially cover Part D costs. Each state has different SPAP eligibility requirements, which can be checked on Medicare.gov.
CMS reports that three million people qualify for Extra Help but aren’t enrolled. Programs like Extra Help and SPAPs can save clients thousands on prescriptions each year, so it’s essential to share information about these resources.
Since financial circumstances can change, encourage clients to contact you if their income or assets decrease. Those newly eligible for Medicaid or Extra Help may qualify for a Part D Special Enrollment Period, allowing them to switch to a new plan.
3. Leverage Connect4Insurance Platforms for Efficient Plan Comparisons
Once you’ve gathered your client’s updated list of medications and determined their eligibility for financial assistance, it’s time to focus on finding the best Prescription Drug Plan (PDP) for them.
If clients have entered their details using Sunfire’s and Connecture’s BlazeSync and RetireFlo tools, quoting PDPs becomes a breeze. These platforms allow you, as their agent, to manage client information seamlessly and generate customized quotes through powerful client management tools.
BlazeSync and RetireFlo pull in all relevant client details, including preferred pharmacy, medications, and zip code, automatically populating their account. This feature ensures accurate quotes tailored to each client’s needs, helping you quickly identify the PDPs that are the best fit.
4. Identify and Recommend the Best PDP
When reviewing options, prioritize finding Prescription Drug Plans (PDPs) that align with your clients’ specific medical needs. Evaluate each plan’s copays, premiums, deductibles, and network restrictions. If a client prefers not to try lower-cost alternatives first, focus on plans that don’t require step therapy. Additionally, look for plans that partner with assistance programs to help clients afford their medications.
As you guide clients toward a final choice, offer tailored recommendations. If they take multiple generic drugs, suggest plans with low copayments. For clients with minimal prescriptions, a low-premium plan may be the most cost-effective choice. Your expertise and thoughtful recommendations will reassure clients that they’re in good hands.
5. Ensure Your Clients Fully Understand Their New PDP
A survey of over 5,000 Americans found that nearly 40% of insured individuals struggle to understand their health coverage, and more than half aren’t confident with basic insurance terms.
Taking the time to explain fundamental health insurance terms to your clients can set you apart and add value to your service. Make sure they know what to expect in terms of prescription costs across the three phases of a Part D plan’s coverage. This clear guidance not only builds your credibility but also strengthens your clients’ trust in you.
6. Share Additional Ways Clients Can Save
To reinforce your expertise, inform clients about additional ways to reduce their out-of-pocket prescription costs. Often, switching to generic or brand-preferred medications can lead to significant savings—ask if they’re aware of this option.
Check whether they can save by using in-network, preferred pharmacies or mail-order services and let them know if these are available. Some pharmaceutical companies also offer assistance programs for certain medications; see if your clients qualify by visiting Medicare.gov/pharmaceutical-assistance-program.
Additionally, ensure clients know they can request coverage for a specific prescription if needed. Their healthcare provider can ask the plan for an exemption if there isn’t an effective, lower-tier alternative. By sharing these valuable tips, you demonstrate your commitment to their well-being and financial health.
7. Remind Your Clients to Reevaluate Their Plan Annually
Although seniors have the option to change their Prescription Drug Plan (PDP) each year, studies show that many rarely review or switch plans during the Annual Enrollment Period (AEP). In fact, a report from KFF found that nearly 70% of Medicare beneficiaries did not compare their coverage options during the 2022 Open Enrollment Period. This means that many might be missing out on plans that could better meet their needs.
At your final meetings, emphasize the importance of reviewing PDPs every year. What was the best choice one year may no longer be the best fit, as plans can change premiums, copays, deductibles, formularies, network providers, and preferred pharmacies.
Your clients might also become newly eligible for additional assistance. Encourage them to reach out, and let them know you’re always available to help them find the right plan. Not only does this advice benefit them, but it also reinforces your commitment to supporting their needs in the future.
PDPs are an ideal cross-sell with Medicare Supplements and Medicare Advantage-only plans. By following these best practices, you can optimize your time, boost your productivity, and increase your profits.
Not affiliated with or endorsed by Medicare or any government agency.
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