Medicare Client Meeting

As previously said, in order to reach Medicare clients, an agent must devote a significant amount of time and effort to marketing and lead generation. As a result, it’s critical that you realize how well prepared you need to be after a customer agrees to meet with you to discuss the possible Medicare plan options with them.

The procedure of meeting with a Medicare client is briefly discussed below, covering the sales appointment, meeting goal, enrollment rules and plan adjustments, as well as how to use visual aids during client meetings and obtain applications. You should be able to get in front of enough individuals, and once you do, you should be able to educate them and explain things clearly. It is not hard-core sales.

Medicare Sales Appointment

Agents should book appointments throughout the year for the following open enrollment period. People who do not need to change plans or who are satisfied with their current plans might be scheduled for future appointments. While you cannot sell at that time, you might offer to consider future plan adjustments. Agents should block off four months in their schedules for spouses or clients turning 65 in the next two or three years. Consider verifying appointments made far in advance or over the weekend. There can be a risk of them changing their minds, but still verify the appointments to make sure when you want to meet, they are available.

Agents should know Part B and Part D income penalty limits. Know the LIS (low-income subsidy)/state pharmaceutical limits for your state. Review all the Medicare special enrollment periods. Know how the trial right works, when people are first eligible and first time enrolling in Medicare Advantage, there is a trial right. There is also a trial right when transferring from supplement to advantage for the first time. They can disenroll for the first 12 months on any month’s first day, for example, if they don’t like their Advantage plan and want to go back to Original Medicare. Have appropriate knowledge of any 5-star PDP plans available in your state. Other product information, like as dental and vision plans, as well as hospital indemnity plan options, should be brought with you.

Set Goals of the Meeting

The objective is to figure out what kind of plan they want and then pick the carrier that best meets their requirements. The majority of clients are unaware of the differences between a Medicare Advantage plan and a Medicare Supplement plan with a stand-alone Rx plan. Agent should explain the differences to them in as simple a manner as possible so that they may make an informed decision. Their personal situation and tastes will influence their decision.

Meeting with clients – Warm up

Introduce yourself and exchange pleasantries as is customary. They should be sharing more information about themselves with you. Describe how you work for a variety of Medicare companies and how you are compensated. Otherwise, they could believe you’ll charge them. Before you begin, obtain a scope of appointment form and explain why it is required. It should be completed before you begin presenting the intricacies of the plans, as they should already be aware of why you are meeting with them and the products you want to discuss.

Knowledge of Medicare A and B

Make sure they know how long they have to sign up. If they get Social Security, they will be automatically enrolled in Part B. If they are not receiving Social Security, they will be automatically enrolled in Part A only.

Every month, it is deducted from their SS check.

If not, you’ll have to pay out of pocket every quarter.

Deductible: The deductible for B is low. Part B will be covered by them. Amounts that A and B are responsible for. Part A of the hospital. Part B covers all other outpatient medical services. Issues include a lack of an out-of-pocket limit and no prescription coverage.

Reiterate goal

Choose one of two methods to cover some or all of the 20%. Choose method for getting drug coverage.

  • Go with Original Medicare, Med Sup and Stand-alone Rx
  • Go with a Med Adv plan

You will explain the difference and go over strength and weakness of both

Enrollment Rules and Plan Changes

Explain the time frames for enrollment: IEP (Initial Enrollment Period), AEP (Annual Enrollment Period), OEP (Open Enrollment Period) and SEP (Special Enrollment Period).

  • Enrolling when T-65 or coming off group
  • Changes during open enrollment: underwritten vs. guaranteed state, trial right, MADP (Med Adv Disenrollment period)
  • Special elections for those making under certain amounts of income, moving etc.

May want to get a general idea of how much they make a month, you should to identify if eligible for drug help

Use a Visual Aid

Many people are visual learners, use a reference. UHC clarity book is a good choice for agents to explain important points to clients. Agents can use any other generic visual aid they like.

Make sure you stress the strength and weaknesses of both options.

Medicare Supplements strength: No network – Medicare is primary, so you can go to any doctors who participate in original Medicare; you don’t have to deal with a network; you can choose a stand-alone drug plan that’s tailored to you through CMS’s website; and you don’t have to deal with much medical management like prior authorizations.

Weaknesses: Part B, Medicare Supplement Plan, and Part D Drug Plan are the three premiums you must pay. It usually comes with fewer extra benefits than an advantage plan, such as vision and dental coverage. Annual physical examination tends to be limited.

MAPD strength: A number of the plans have no monthly premium (still pay Part B however)

  • Most 0$ plans include prescription drug coverage
  • Additional benefits such as dental, vision, hearing, and fitness club membership may be available
  • Some Medicare Advantage plans offer Part B give back but it isn’t available in all areas
  • An annual physical examination

Weaknesses: Advantage plans are network based. Medicare is not primary or secondary

  • Copays can add up in a bad year (up to the out-of-pocket max)
  • Managed care plans can require prior authorization for some services

Results and tips from the clients

The prospect/client will give you clues as to what they want:

  • I don’t like much care and like the idea of not paying premium = Med Adv
  • I go to the doctor about 6 times a month and am in the hospital often = Med Supp

Don’t assume, ask and listen to their clues and decisions.

If they want a Med Supp

Examine plans F and N with them. Consider high-deductible F, K, or L plans, but don’t give too many options. Remember that most businesses provide a spousal discount. Study the distinctions between plans and pricing if you are unfamiliar with them. The high deductible F plan is fantastic, but it can be tough to educate clients about it.

If they want Stand-alone Drug Plan

Best to get list of medications and pharmacy and use the CMS drug plan finder. If not, you can bring formularies and see which of the plans you have fits best.

If they want Medicare Advantage plan

Check the list of their doctors if accept insurance plan. Check prescriptions. Review summary of benefits (use benefits at a glance), explain a trial right if needed.: taking an advantage plan when turning 65, trying an advantage plan at some point coming off of supplement into the advantage plan for the first time – 12-month trial right

How to get application / conclude meeting

If during OEP you are all set. Take the application. Pre AEP, Oct 1- Oct 14, fill out the application and leave it with them to fax, mail or scan and email back to you or you can pick it up. Do not sign or date the application; only your name and agent number should be signed and dated once you have it.

During MADP (Jan 1 – Feb 14)– they could go to a supplement and drug plan if they don’t like the MAPD. If they have LIS then us a SEP. Know your state’s MSP income levels and rules.

Fill out application for your client unless they really want to do it themself. If they cannot decide, fill out multiple applications and leave them there so they can figure it out. Do not take applications and hold them. If they want to keep the same plan, fill out an AOR if they want you to be their broker.

If not appropriate to do anything, tell them about AEP and set an appointment for then. Fax in application with your scope (SOA) to Pinnacle Financial Services or the carrier. Essential Care suggests to send it to Pinnacle, but that is up to you.

Send in the MSP/EPIC application if you completed one of them. Get their email address if they have one and create a monthly email list. Make an appointment to discuss any additional plans the client has expressed an interest in. To compare Medicare plans, go to and use the Pinnacle quote engine. Sign up for username and password.


For more information, please contact our office at 347-971-3399 or send an email to

Essential Care Insurance Agency also provides Free Programs and Sales Tools for our Agents.

Please click on each link to learn more.