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Helping Members Find the Best MAPD Plan

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Two decades ago, a gallon of gas cost less than a dollar. There was no law requiring seatbelts, text messaging involved using numbers on a pager, and the marketing rules governing Medicare took less than 15 minutes to read and understand. How times have changed. Whether driven by inflation, technology, or policies designed to protect, change is unavoidable. Yet as inevitable as change is, people are adverse to it by their very nature.

For agents selling Medicare plans, change has come in the way of hundreds of pages of new rules governing everything from what defines an educational meeting to what food can be served, and from the number of calls you can make to a prospect to exactly how much your commission check will be. These changes, commonly known as the Medicare Improvements for Patients and Providers Act (MIPPA), were made largely in response to the unscrupulous practices of a few and are intended to, as the title suggests, protect patients and providers.

While MIPPA has restricted the ways in which you’re able to market to seniors, it hasn’t changed the fundamental, supportive relationship you can have with your Medicare clients. Likely, some of your Medicare members have been with the same health plan for many years, and may not realize the different options available to them.

How can you be sure your clients enrolled in Medicare Advantage Prescription Drug Plans (MAPD) have selected the plan that best meets their financial and health care needs? The window to make a switch remains open until March 31. Armed with the annual notice of coverage, which they should have received at the end of last year, and their first premium notice for this year, MAPD members have one more opportunity to choose the right coverage for the rest of the year. Reviewing this information with your clients is a worthwhile investment of your time and their future.

Just as Medicare plans’ benefits change from one year to the next, so do members’ healthcare needs – making it critically important to reevaluate the coverage they need and out-of-pocket costs they will incur during the coming year. Here are five simple steps to help your clients determine the best plan for them.

  1. Compare the costs associated with each MAPD plan being considered. Look at monthly premiums, annual deductibles, copayments, total annual maximum out-of-pocket costs, and hospital charges.
  2. Carefully review each plan’s formulary, the list of covered prescription medications. Ask the following questions about each plan:
  • Are current prescriptions covered? At what cost?
  • What is the coverage for generic drugs?
  • What is the coverage for brand-name drugs?
  • What is the coverage for “specialty” drugs?
  • What kind of coverage is provided during the donut hole?
  1. Assess the number of and access to providers.
  • Is the client’s primary care physician in the provider network?
  • Do the local hospitals have agreements with the insurer?
  • Does the company have an extensive list of specialists, conveniently located to the member?
  1. Test their customer service. Call the customer service number before you suggest clients sign up for the plan. Who answers the phone? Most clients will prefer a live person to a recording, and a long wait time indicates an overworked customer service staff. You’re looking for representatives who are friendly and helpful, and there when the clients need them – so be sure to compare customer service hours, too.
  2. Find out what types of additional services each health plan offers. Value-added benefits can be the tiebreaker between two plans that are otherwise comparable.

Investing the time to make sure that your MAPD members belong to the plan that works best for them will serve both of you well in the long term with more satisfied clients who will stick around for years to come, and may provide referrals.

Tom Lescault is the president of SCAN Health Plan Arizona, which is a part of the nation’s fourth-largest nonprofit Medicare Advantage plan. He can be reached at 866-490-7226.