Four essential topics to cover during your AEP appointments

I’ve gotten a number of calls this week from agents asking “Where do I start?” They’re wondering what’s the best way to compare beneficiaries’ choices for Medicare coverage during this busiest time of the year, the Annual Enrollment Period.

Do a simple needs analysis to figure out what your client’s greatest health needs are, then start a conversation that hits on these four topics: Doctor network (HMO, HMO-POS, PPO, etc.); maximum out of pocket cost (MOOP); prescription formulary and cost sharing. Of course, let your client lead the discussion.

Let’s break down this list some more to get an idea of what information you can give to your client to help them make the best decision.

With so many carrier acquisitions and health company mergers, doctor networks tend to be seniors’ No. 1 concern (“Is my doctor in my network?”). Most of my clients are very comfortable with their doctors, having been their patient for years. They’re typically not willing to give up their favorite PCP or specialist. However, I’ve noticed that some seniors are willing to give up their doctor in order to keep a nearby hospital in their network. Help your client make sure their preferred providers and hospitals are going to be accessible to them after their new plan goes into effect.

If your client has had a tough year financially or healthwise, are they going to be able to afford a plan’s maximum out of pocket cost? Most clients don’t seem to make MOOP a priority, but it has been my experience that agents need to stress how much their clients could have to pay out of pocket if something catastrophic happened during the new plan year —something like a stroke or a cancer diagnosis. Any of my clients who have hit their MOOP have always done so with a combination of issues, whether it be a stroke, an ambulance ride and PT or speech therapy to help them recover. I’ve had a few clients who have been diagnosed with cancer and held responsible for 20 percent of their chemo treatments.

Are their prescriptions covered in the plan formulary? Check each formulary and confirm your clients’ drugs are covered. If they’re not listed, explain how to get them covered or changed. For 2016 many plans are including a deductible on non-generic tiers, or their cost sharing is being raised. No, generics will not be spared either. If your clients change to a different plan this AEP, make sure they know what their prescriptions will cost. Getting a call the from your client asking why they now have a $5 co-pay on their tier 1 prescriptions when it cost them nothing last year is not a fun way to start the new year off right.

When discussing premiums and cost sharing with clients, the rule to keep in mind is “the larger the network, the more it will cost.” Some clients like the all-in-one delivery model that some HMOs are starting to transition into. Some will only sign up with a PPO to give them more control over who they can see. If a client is balking at the cost of a specialist visit, remind them that they will pay more for a larger network. If they have something more serious like cancer to attend to, the extra $10 to $15 it will cost for a specialist is nothing compared to the value of their health. If you know your client is going to have a hip or knee replaced, physical or occupational therapy may be high on their list too. At that time a $15 difference in co-payments could have a huge impact on whether they receive all of the therapy they require to recover fully.

Every client is different, and some may have certain preferences they can’t live without when shopping for a Medicare plan. Your needs analysis may lead you to a Medicare Supplement if they can afford it. In that case, you may want to call me at (800) 997 3107 or email me with the question, “Can they pass underwriting?”

It’s my pleasure to help agents get up to speed on what you should be asking your clients to best serve them and secure their loyal business.

Like what you read? Subscribe to The Agent’s Advantage blog for more in-depth sales practice advice.

Elder abuse or neglect and how to report it.

Any agent who’s been working as long as I have with Medicare beneficiaries has stories to tell. Some are heartwarming, some are humorous, some perhaps are disturbing and others are just heartwrenching. I could spend all day telling you all about the experiences I’ve had, but let’s get serious for a minute.  The story I have for today is about elder abuse or neglect, and highlights why it’s important for independent senior insurance agents. I encourage all agents to take a moment to read up on their state’s Department of Economic Security/Adult Protective Services (DES/APS) resources, and here’s why.

As an employee agent with a large national carrier some years ago, I was blessed to work with an in-house social worker team. We had great training on what to watch for and which situations we should report to the team. I was lucky to make a few reports of what I considered shocking situations regarding the physical welfare or emotional state of a Medicare beneficiary to the team. They knew who to contact among government and assistance agencies.

Well, for about the last 15 years I have worked as an independent agent without having recourse to that wonderful team. Just last year a “new to Medicare” client who was also eligible for a Dual Special Needs Plan was referred to me. She was obviously in distress.

This client had recently been granted permanent resident alien status and full Medicare-Medicaid eligibility through her American husband’s U.S. citizenship (He was born in the United States but had moved back to India, where they later met and got married). Shortly after the couple relocated to America in 2013, the husband passed away. There were no other family members my client could turn to — they were all back in India.

She was barely literate and had never acclimated to American life, living in a condo she had owned with her late husband. It was falling into neglect, and the power and water had been shut off. My client only had natural gas service to her unit, and she was gathering water from the common area hose. You get the picture — she needed some help.

I reported the situation to Arizona Adult Protective Services (APS). I made the referral online on an anonymous basis because there was no second party abuse or exploitation. I will add that all reports are confidential in my state.

The next time I visited with my client her condo was spic and span, hooked up to full utilities. She was now connected to a number of other services as well. Most importantly, she had been assigned a social worker that spoke fluent Hindi, her native language.

Help is out there for vulnerable seniors, and we Medicare agents can do our part in facilitating the connection. Self-neglect becomes a major issue as people who live alone or do not have close family members age and deal with health issues like dementia. Seniors also face the risks of exploitation and abuse — be it financial, physical, emotional or sexual. A nursing home does not protect them from these risks, either. APS works with law enforcement, courts, non-profits and other groups to protect seniors.

Take a minute and check out your state’s APS website because you never know if you will encounter elder abuse or neglect in the field.

RBI takes the welfare of the members we help very seriously. If you encounter elder abuse or neglect, and don’t know what to do about it, please call our office at 1-800-997-3107 and ask for advice! 

The straight facts on observation status and Medicare

According to, there was more than a 400 percent increase in Medicare-recognized observation status hospital stays lasting up to 72 hours between 2006 and 2011. Observation status means a beneficiary receives hospital care without being considered inpatient, making them ineligible for the Medicare Part A benefit as they transition to skilled nursing facility (SNF) care. Hospitals are currently not required to disclose observation status to patients. Patients may learn about their status if they ask first, but the unfortunate reality is most of them discover they were not inpatient and did not have their SNF care covered by Medicare when the bill comes.

Medicare requires beneficiaries to stay in the hospital for a minimum of 72 hours before it covers SNF care. Calculating the three hospital days can be complicated, however, due to how the rule is written. Health care policy experts say care improvements have made the rule outdated and an obstacle to accessing SNFs for seniors — three days is now a long time to treat many common senior health issues. What makes this rule especially challenging for beneficiaries is “observation status,” which does not count toward the three days necessary to unlock the SNF benefit.

This will change in August 2016. Congress passed the NOTICE Act this summer, which requires hospitals to give written notice of observation status hospitalization that lasts more than 24 hours to Medicare beneficiaries within 36 hours of their stay. This reform will protect seniors from unexpected bills, but it will not be implemented until next summer.

So, what can you do now to help your clients avoid high costs related to hospitalization and SNF care? First and foremost, remind them to be proactive about their health care and to ask questions. Talk to them about their Medicare rights and specifically go over how Original Medicare counts hospital days for the SNF benefit. If you’re selling Medicare Advantage during AEP, your client will appreciate knowing that most of these private Medicare plans cover SNF care from the first day.

Agents also have a year-round opportunity to sell hospital indemnity products to their senior clientele as well as non-Medicare-eligible individuals to help them out. Just remember these products may cover your client under observation as well as admittance depending on the company — it does not equate to the minimum essential coverage.

Mastering sales is just like learning to ride a bike

I remember I had just started a new sales job when it was time to teach my oldest son, Chaz, how to ride a bike. It wasn’t easy at first because he didn’t want to ride it without the training wheels. Until one day some neighborhood kids laughed at him.

“Dad, I want to take the training wheels off,” he said, holding back tears. 

I had encouraged him to take them off weeks earlier, but I didn’t press him. I knew there would come a time when he would want it bad enough to pursue it without carrot and stick motivation. We took the training wheels off and he got on the bike. The extra little wheels that made the bike safe were gone, and for the first time he couldn’t place both his feet on the pedals unless he moved forward. He had to build momentum.

Our long driveway was mostly straight and had a slight grade. I started him in the middle and held on for several attempts as he pedaled, learning balance and steering. At about the tenth time, I took him a little higher up the driveway and we began going down the hill. As you have probably guessed by now, I let go.

I still continued to let him know I was there, but at this point he was doing it all on his own. He was still telling me to hold him, not knowing I had already let go. He looked over his shoulder and saw I wasn’t there. He panicked and fell. After he checked for broken bones and realized he was OK, I started to laugh.

He did too. Through that experience, I learned that riding a bike and getting better at the sales process have a lot in common. You may already have drawn from this life metaphor things that relate to your own experiences, but there are a few specific things I want you to focus on the most.

  • Know your fears. What really scares you?  For most sales professionals, it’s rejection. The antidote? Don’t take it personally. Get over it! Rejection is going to happen because it’s part of the process. For others, fear of failure is at the top of their minds. It’s overcome by making goals, visualizing success and taking action in spite of conditions and circumstances. Movement is the best cure for this fear. Be persistent in spite of rejection or temporary failure. One lost opportunity or setback does not make a winner quit. They keep going. Resolve to be persistent until experience brings you competence, which will in turn give rise to confidence.
  • Know your product. Many sales people have not taken the training wheels off. They constantly need someone to help them with the products for which they should be the experts. Memorize your products’ features. Convert them into benefits your clients need.  Know what your product will do and what it won’t do. If possible, experience the product at work in your life and through your clients’ experiences. You must understand how your product will meet your clients’ needs.
  • Know your limitations and stay on the straight path. Most sales people don’t start with finesse and skill. They start out as order takers. Order taking may help you close 15 percent of your opportunities, but is not the way to build momentum for a sustainable career. How do you get to a 60 percent closing rate? Through the experience of objections, rejections, falling and failing. The school of hard knocks will teach you the little things along the way that help you evolve — to help you get better.

When I think of how I got started in sales, I am amazed and humbled by my success. Then I remember Chaz on that bike. Less than six months later he was building ramps and jumping over boxes. He had converted fear into skill. That skill brought confidence in trying new and daring things. For sales professionals, that translates to new opportunities for growth and development, facing a new set of fears and challenges with faith in your abilities.

Having seen thousands of sales people make the same progression, I’m qualified to say that mastering sales is just like riding a bike!

Cross-sell ACA, Medicare during overlapping enrollment periods

Most of the time RB Insurance Group is a marketing organization for the Medicare side of health insurance. We’ve been busy these past few months getting independent agents Ready To Sell a portfolio of Medicare Advantage and other senior products for the Annual Enrollment Period, which started October 15 and ends December 7 this year.

Did you know we also have a few opportunities for agents interested in selling individual plans connected to the Affordable Care Act (ACA)? Open enrollment for federal and state ACA markets started November 1 and will continue until January 31, 2016. It overlaps a fair amount with AEP. Cross-selling ACA and Medicare to families will help you take advantage of the overlapping enrollment periods.

If the idea of a double sales rush makes you feel exhausted, remember that a vast majority if not all Medicare beneficiaries have kids, who may also have kids of their own. You can generate ACA Leads from your Medicare book of business relatively quickly, especially if your senior client has been happy with your service.

Marketing your ACA products and Health Insurance Marketplace expertise should be less complicated than marketing your Medicare business because CMS currently does not have guidelines set for ACA. Cold calling and leaving door hangers may be illegal for marketing Medicare, but you can do them for ACA. Just be careful — if you’re at the kitchen table with a married adult couple who’s taking care of grandma at home, you’ll need to be able to switch gears when discussing ACA plans with the couple and Medicare with grandma. You’ll need to fill out a Scope of Appointment for any interaction you have with a Medicare beneficiary. Getting a referral from a family member is an excellent way to get permission to contact a Medicare beneficiary.

If you’re focused on running as many Medicare appointments as possible, consider hiring someone to make cold calls for ACA plans based on leads you pick up or receive from a marketing organization like RBI. It’s legal, and it will save you time and energy.

Call RB Insurance at 1 (800) 997 3107 or email Sales Manager Charlie Ferrell to learn more about our ACA contracting opportunities. Receive important Medicare policy and compliance updates in your Inbox. Click here to subscribe to The Agent’s Advantage newsletter.

What could be better than saving a senior $300 a month?

What could be better than saving a senior $300 a month? Every year I meet two or three people who do not know they are eligible to receive Low Income Subsidy (LIS) benefits to reduce their prescription drug costs or have their Medicare Part B premium covered by Medicaid. Once I sit down with these folks at the kitchen table and help them see real savings, I know I’ve made a meaningful impact in their life and can add a lifetime client to my book of business who would be more than happy to send friends and family my way.  You can do this too.

You can save your client up to $300 a month or more by helping them apply for LIS and other Medicare Savings programs that do not require them to be a full dual-eligible. Individuals who make between 100-135 percent of the federal poverty level can apply to have their Medicare Part D premium covered and their prescription cost sharing significantly reduced as well as their Medicare Part B premium covered. Click here for a link to your state’s programs.

I recently went on an appointment with one of our new career agents in Arizona, and we helped a woman save $325 a month. Taking away her $35 Part D premium and reducing the cost of her prescriptions she takes she saved $225. We also saved her $104 a month on her Part B premium. It gives you a good feeling inside when both you and the client have tears in your eyes because you have had such a profound effect on their lives.

If you can help a senior that is on a fixed income save more than $3,600 per year, it will make a huge difference in their lives. Based on my experience, saving a senior $300 a month is significant: the difference between being able to afford medications or groceries. The data doesn’t lie either: Senior hunger is a real problem in our country. You can do a good deed and build your book of business by sharing your knowledge of Medicare Savings Programs.

Agents who are knowledgeable of these available programs really have an advantage over other agents who just say “I have nothing for you” or “I can’t help you.” Even though you may not have anything to sell that prospect, helping someone enroll in LIS or a Medicare Savings Program is a very positive way to spread the word about your business. Remember, you’re a senior insurance advisor, so that implies you sometimes offer pro bono advice. The bottom line is referrals are the easiest way to generate Leads, so you may see some sales from these connections for Special Needs Plans or other products.

Are you looking for more information on where to get started saving a senior $300 a month?  Click here to watch a recorded webinar about LIS and how you can implement these practices in your business! Call our office for more information at 1-800-997-3107!

Stand apart from the competition this AEP — be yourself!

How has AEP 2016 treated you so far?

We’re rapidly closing in the the halfway point of AEP. Besides dealing with the challenge of having so many people to see in so little time, one of the recurring frustrations I hear from agents this time of year is “Everyone is after the same people.”

This definitely stands to reason. Large carriers have commercials and infomercials on 24/7 directing them to call or go online, mail is getting delivered to eligible beneficiaries in high volume and agents probably just left the house you are walking into, while another one follows behind you.

Within the sales process, there are three things you can do to save yourself from the clutter and competitive chaos that makes AEP what it is.  If you can do these three things, you will be the sales person of choice for more clients, even if they have seen other sales peopleThankfully, they’re simple. However, my observation has been that the vast majority of sales people do not do them, which means they do not stand out.

1. Prepare. When you do prepare for your 1 p.m. sales call?  I hope you didn’t say when you’re in the driveway! The best time time to prepare for your day is early in the morning or better yet, the night before. In-depth review of your client’s situation will provide you with a higher level of confidence that you have the right product and approach to meet their needs.  Nothing says professionalism like preparation.
On the other hand, nothing turns clients off faster than a sales person who seems discombobulated.  It makes them feel as though they weren’t important enough for you to spend time getting ready for them.
2. Be meticulous with detail.  The first place to impress the client is at the door to their home. Be on time, dress appropriately and be in control (Read No. 1 again if you have to). Using and remembering names is critical.  If kids are present, include them in elements of the discussion — it will reflect positively on you.  As you conduct your demonstration and ask questions, take notes. What your clients say is worth taking down because it’s important to your book of business, and the gesture also shows your client that their voice matters to you.  Reflect active listening skills by restating what you have heard.  Show them you are focused on their needs.
If follow-up activity is necessary, create timetables of deliverables or dates and times you will call back with the additional information. Just make sure that you actually do it!  Just in the last month, I have had three service people neglect the promises they made to follow-up. It has become so acceptable to provide slack service, that if you simply do what you say, you will set yourself apart from the majority.
3. Dare to be different and memorable.  I am not asking you to be “salesy” or over the top, but you do have to do something that cuts you out from the clutter.  It could be a business card with your photo as a magnet for the refrigerator. It could be a monthly newsletter that includes inspirational articles, especially if you’re like me and enjoy writing. You could use a CRM tool that provides you with special reminders. Get an interesting company or agency name or logo. Simply staying in contact with sincere, personalized messages will give you a recognizable brand!
Doing these three things as an ongoing part of your sales process will allow you to stand out from the competition this AEP. You’re one of a kind, so leverage it!

Your game-changing mid-AEP pep talk

Between babysitting their existing book of business and chasing down quality leads to create new business, agents are bound to be feeling a mixture of exhaustion and frustration at this point of the Medicare Annual Enrollment Period. Can you relate?

Don’t worry. If you’re not seeing the success you think you should as we reach the halfway mark, you still have time to turn things around. 

My advice for agents looking to strengthen their sales practices is to focus on time management and asking for referrals. Make sure you’re keeping as many appointments as you can by planning your day in advance. Be honest with yourself about your work capacity and make wise investments to make sure you don’t fall behind (I recommend reading my recent posts on hiring an administrative assistant or compliant meeting spaces that require less travel to help you further see my point). Before you wrap up with each of those appointments, remember referrals.

Asking for referrals makes a lot of agents uncomfortable because they may have never learned how to do it properly, and some agents just plain forget to ask. It’s a shame because referrals are more than the greatest “thank you” a client could give you — they’re also the easiest leads to pick up.

It’s simple: Referrals are a natural part of the conversation during an appointment. If you’re making appointments with clients in their homes or at a coffee shop to answer questions about a plan or to review any plan changes, you’ve already set the stage by showing your expertise and that you can understand seniors’ specific health and financial needs. Hopefully you’ve made an effort to keep in touch with them throughout the year or have made yourself available for phone calls or emails.

It’s not impolite to remind your clients that referrals are the best way for them to thank you for your efforts. Being an agent is your business — it’s also how you pay for your daughter’s tuition or buy diapers for a little one. Don’t belabor this point as you let them know you appreciate them putting in a good word for you with their friends and family. They will more than likely be able to think of someone if you’ve provided excellent customer service and have helped them meet their needs. This mindset will pay you big dividends for years to come if you convert your new Leads and factor in renewals.

A book of 300 clients is typical for an agent. If each of these clients gives you just one referral because you find a way to request it in your sales practice, you could have 300 fresh Leads.

Remember: Plan your work and work your plan. AEP will be over before you know it. Now get back out there and help everyone you talk to see the true value of your knowledge and services for their health care needs.

Click here to subscribe to The Agent’s Advantage blog to read more of CEO Bob Bever’s special AEP series in your Inbox. You will receive one weekly newsletter during AEP.