Be aware of these important, but often missed SEP opportunities

I took a call a few weeks ago from an affiliated agent asking me when his prospective client would be able to switch from a Chronic Illness Special Needs Plan (C-SNP) HMO he no longer favored to a MAPD HMO he was eligible for, even with his illness. It turns out the agent called me while he was in the appointment.

While still on the line with me, the agent began to tell his client he would probably have to wait until the next Annual Enrollment Period to change plans. I politely interrupted, asking if the client had some other special election period option (SEP). The agent said, “No, he makes too much income. The only help he gets is Low Income Subsidy (LIS) Extra Help for medications.”

Get familiar with CMS’ most common Special Election Periods to take advantage of more selling opportunities. Clients will appreciate the special attention you’ve given to their unique health situations.

SEPs are where most agents turn a blind eye.

It is estimated that, depending on the state, 23 to 28 percent of Medicare beneficiaries are eligible for some sort of SEP, which means they may change plans at any time or specifically during the lock-in period of December 8 – October 14. SEPs thus constitute a huge block of potential year-round business outside AEP.

Back to the phone call: I reminded the agent that the LIS prescription help qualifies the client to complete an enrollment form right then and there, using the SEP provided to LIS beneficiaries.

The agent secured the sale and earned a grateful client by taking advantage of the SEP.

Take some time to become familiar with SEPs. There are over 40 time-sensitive or year-round SEP categories when counting Medicare Advantage and PDP situations, all to be interpreted as chances for you to gain more trusted clients. Here are a few of the more common examples:

  • Beneficiary moves out of current service area
  • Low Income Subsidy prescription Extra Help or state prescription assistance program and Loss of LIS Subsidy (Yes, it does happen!)
  • Medicare Advantage Disenrollment Period (MADP) for PDP
  • Institutionalized (My favorite one. Includes moving into or out of a facility — additional rules apply!)

Even if you’re in an appointment when a question pops up in your mind, our affiliated agents can feel free to call RB Insurance at

(800) 997 3107. Ask for me, Tom O’Neil.

Think of Medicare.gov as your sales asset

Most independent agents offering Medicare Advantage and Part D prescription drug plans are at least generally aware of Medicare’s official website, though relatively few of them think of it as a sales asset.

Medicare.gov is a handy tool for determining MA plan availability by ZIP code, and it also offers filtering options to determine a client or prospect’s Medicaid and/or Prescription Help eligibility level for a Special Needs Plan. Additional filters can display Chronic Illness Plans available for qualified beneficiaries. It’s the perfect resource for helping your clients or prospects find the best plan for their budget and health needs.

Prescription medications can be entered into the program to compare both MA and PDPs against the formularies on record with CMS. The drug list and plan comparison can be retrieved anytime with a simple, anonymous code and entry date auto-generated by the site. 

Medicare.gov’s Plan Finder is a great way to give your clients and prospects credible information about MA and PDP availability and eligibility for Medicaid and Prescription Help. Photo courtesy of iStock

Some agents are not aware they can print detailed comparison information from the site on behalf of their client or prospect. This very credible CMS-generated information comprises general copay details for both medical and prescription benefits, star ratings and reduced premium quotes for beneficiaries awarded LIS Prescription Help. More detailed information can display monthly medication costs, drug restrictions and even an estimate of when a plan member might enter the prescription “donut hole” and exit into catastrophic medication coverage.

Medicare.gov is a tool that can be especially beneficial to agents who represent a broad offering of MA plans and PDPs in his or her marketing area. An agent printing a side-by-side comparison of up to three plans from Medicare.gov can let your client or prospect know they can be confident you are giving them valid and useful information. This personalized comparison can be saved and retrieved from the website at any future time.

Independent agents affiliated with RB Insurance who’d appreciate a more detailed tour of Medicare.gov can give me a call at (800) 997 3107 or email me to schedule a personalized, 15-minute training tour of this site with an emphasis on closing sales with this fully compliant client-facing information.

Here’s a helpful video I’ve found from The Oregonian that gives a good rundown of Medicare.gov’s Plan Finder.

6 Secrets of 6-Figure Advisors: Part 3

At last, the final two secrets:

6 -Figure Senior Insurance Advisor’s Secret #5: They don’t focus on production, they focus on running their business.

Try this. Ask three of your friends in the business how things are going. I can almost guarantee (unless they read this!) their answer will be production-focused.

“I sold 60 MAs this AEP and won’t get paid until mid January — I’m not sure how I’ll make it.”

“The leads have dried up, and my FMO doesn’t have a free Lead program.”

“I only sell Medicare Supplements. Life insurance renewals are too low for me to consider selling that product.”

While these are all valid concerns, running your own business focuses on three core ideas:

  1. Margin: How to make money in all environments, year-round.
  2. Core Competency: Concentrating what the business does better than most of the other businesses?
  3. Tactical planning: Doing the day to day things necessary to run a profitable business.

Within these three core ideas, there are many other elements such as: Objectives, strategies, tactics, revenue and expenses, marketing, etc. All of these are required in order to get out of simple production mode and into running your business!

6 -Figure Senior Insurance Advisor’s Secret #6: They know they cannot do it alone.

Yes, I know sales is an individual sport. I know you eat off the land and that you have to be self-reliant. I understand that everyone who says “Come and go with me,” is not seeking synergistic, everyone-wins relationships. That said, you can only go so far on your own.

It seems like all the secrets have three elements, and this one will be no different. The impact of Strategic Teaming:

  1. It was Aristotle who said “The whole is greater than the sum of its parts.” A fitting quote for running your business. Teaming gives you access to economies of scale. You are not giving up control. When done properly, everyone will do their part, take their fair share of the harvest based on the value provided.
  2. Access to new and bigger opportunity. Sure, the rich get richer. Why? They merge and partner. They see an opportunity and know that there is more than enough. Case in point; Alibaba. The largest company in the world doesn’t actually sell anything, it partners with businesses (small and large) that do.
  3. Many hands make work light. The things you struggle to do (administrative work,  Lead generation and management, commission reconciliation, etc.) are best accomplished through delegation and sharing of resources that would be too expensive if done on your own.

Whether it’s an FMO that has products and tools you can’t access on your own or a newly hired assistant who can make the calls to set the stage for your upcoming weeks’ activities or a dynamic training program like 6 Hours to 6 Figures that may give you the extra “Ooomph,” you need a team to support you to reach the next level. You need a team to support you.

“If you want to go fast, go alone. If you want to go far, go together.” African Proverb

There you have it — the 6 Secrets of 6-Figure Advisors. Some of them may seem daunting, but they are all doable. If it were easy, every one would do it. Separate yourself. Join the club!

2015 is in full gear. If you take these six secrets to heart, I believe you have enough time to cross the 6-figure finish line. Join the ranks of the exclusive (but accessible!) $100k+ club and take your business to another level. That is my goal for you. I know you can do it!

Until then, I wish you Money, Power, Success!

15% off Medicare leads until May 1!

Now until May 1, we’ll send out 1,000 pieces of our guaranteed-response Medicare leads mailers for you for $380 — keep in mind that our standard price is $445 when the average cost of 1,000 pieces in our industry is $500!

As part of our Massive Response Mailer promotion, here’s a quick rundown of how we’re sharing this great value to make leads happen for you:

We start by creating our own 4.25″ x 5.5″ bifold double postcards. We have postcards for Dual-eligible, LIS, Medicare Supplement, Hospital Indemnity and Special Interest mailers available to help you reach Medicare members interested in the range of carrier products you are contracted to sell. Completely compliant, they feature a business reply card interested Medicare members can mail back with their contact information.

We don’t charge you for the mailing list you request or the business reply mail it generates, and we keep your list exclusive to you for 30 days. Responses come to our office, where we process and load your leads into your Medicare Sales Engine account.

We do all this so you can focus on starting a conversation about finding the perfect plan with your prospective clients.




How to build a compliant MA Agent website that works (Part 2)

Here’s my follow-up on tips how to compliantly build your own Agent or agency website. In this article I will be discussing required disclaimers for generic Medicare Marketing sites. Click here to view the CMS memo on this topic.

Required Disclaimers For Generic Agent/Agency Websites:

Agent's Advantage Blog
1. “Medicare has neither endorsed nor reviewed this information.” (See section 50.13 – Disclaimer When Using Third-Party Materials)

2. “Not connected or affiliated with any United States Government or State agency.” (This is also required by some states)

3.  “Calling this number will direct you to a licensed Agent/Broker.” (Include this if your site has a contact number that directs potential clients to you or a sales team.)

These three disclaimers will satisfy passive Agent/agency websites intended for Medicare beneficiaries that are generic and do not mention specific plan names, benefits, premiums or marketing materials and do not collect any beneficiary’s information. You can read the Medicare Marketing Guidelines here — many of these disclaimers are included within that document.

Disclaimers for Sites Collecting Information for Lead Generation:

If you choose to collect potential clients’ information on your website, also ensure you include the following disclaimers for your form submissions:

1. “By submitting this form and providing this information, you agree that an authorized representative or licensed insurance agent may contact you by phone, e-mail or mail to answer your questions and provide additional information about Medicare Advantage, Part D or Medicare Supplement Insurance plans.”

2. “This is a solicitation for insurance.”

This is by no means intended to be a complete list. In fact, there are many do’s and don’ts for the content of your website in addition to just the disclaimers listed above. You can view Aetna’s recommended do’s and don’ts by clicking here.  If you utilize your website for Lead generation or advertising your agency, the disclaimers and do’s and don’ts above will address many of the concerns CMS cited in their memo to Plan Sponsors.

But what If I want to list my contracted Plan Sponsors on my site and Compare Benefits?

Be prepared to submit your site for compliance review to each plan sponsor your list on your site. You must receive approval from each carrier for use of their name, logo and plan materials on your site. Your plan sponsor may also requires your site to be submitted to CMS for official review and approval. Speak with your plan sponsor’s marketing or compliance department for specific guidance on the use and publishing of their plan materials.

Build an attitude of confidence through compliance with your plan sponsors, your clients and yourself. You’ll be so happy you did when your site comes across the desk of a Plan Sponsor’s Compliance Officer, as new regulations now require CMS to audit plan sponsors and their contracted downline entities for compliance every other year.

Interested in learning more? Email me or call (800) 997 3107 to start a conversation about disclaimer and marketing guidance for sites listing and comparing plans and benefits.