10 Real-Life Medicare Sales Scenarios & How to Handle Them

You’ve got a call from a client or prospect with a Medicare insurance problem, and they’re counting on you to help. Are you prepared with the solution?

We want to help you handle whatever that client throws at you — even if they have several major medical conditions and a long list of prescriptions!

That’s why we’re providing you with a Medicare sales playbook for troubleshooting some common issues you may encounter! Let’s get started.

1. Client Missed Medicare Part B Sign-Up Deadline

Scenario: I wrote a client into a Medicare Supplement with an effective date for the next month. He was supposed to sign up for Part B with the same effective date but forgot. It’s been a little over a year since he lost his employer coverage and should have enrolled in Part B.

Solution: First, check if your client is eligible for a Special Enrollment Period. If he isn’t…

• Have him call 1-800-Medicare and ask for an exception. CMS may be able to get him on Part B and may even waive the late enrollment penalty.
• If this doesn’t work, it’s likely your client will have to wait until the next General Enrollment Period to sign up for Part B.
• The Med Supp application (and its commission) will be rejected until your client is eligible to enroll.

At future appointments, verify clients have Medicare Part B before writing an application or reach out to the client a few days before their deadline to remind them they have to sign up.

2. Client Needs Hip Surgery, Wants a Med Supp

Scenario: I have a client who needs hip surgery. He’s currently enrolled in a Medicare Advantage Prescription Drug plan and wants to switch to a Med Supp.

Solution: Was your client told by his doctor that he’d need this surgery? If so, he probably won’t be able to pass underwriting into a Med Supp until after his surgery (and possibly any therapy he needs as a result of it).

Before telling him he may have to wait, you could check if he has a guaranteed issue right. These vary by state, but here’s a list of the federal ones.

Not sure if a client will have to pass underwriting? Check out A Comprehensive Guide to Medicare Supplement Underwriting for an in-depth look!

3. Client Needs Extra Help Paying for Prescriptions

Scenario: I met with a woman who just aged into Medicare and takes several medications costing thousands of dollars monthly. She was enrolled in Medicare Parts A and B and was auto-enrolled in a prescription drug plan because she applied for and was granted Extra Help. She’d like to start taking her Social Security benefit in order to afford a Med Supp, which she could use; however, this could cause her to lose her Extra Help eligibility.

Solution: Does your client qualify for Medicaid? How about a Dual Eligible Special Needs Plan?

You could help your client set up and prepare for an appointment with a Medicaid caseworker. Additionally, you could check if she’s eligible for a State Pharmaceutical Assistance Program or any drug manufacturer rebates.

There are also a few simpler ways to save on drug costs that your client might not be aware of. Make sure she understands the value of buying generic vs. brand-name prescriptions and using in-network or mail-order pharmacies.

4. Simple Medicare Sales Pitch Needed

Scenario: I sell all the major MA, Med Supp, and PDP plans. During my presentation, I try to educate clients about all their Medicare options, but by the time I get through my spiel, they seem too overwhelmed to make a decision that day.

Solution: If your clients seem overwhelmed by all the facts, you may be over-educating them.

• Make your pitch more like a casual conversation, rather than presentation.
• Focus on finding out their coverage needs and what they value in a plan, not the options themselves.
• Ask questions, especially simple ones like, “Are you open to seeing a new doctor if it means you could save money?”

After this, you can briefly tell them about the types of coverage they can get and which type you think best fits their preferences and why.

5. Agent Error on Medicare Application

Scenario: I mistakenly checked the wrong box on an application and enrolled a client into the wrong MA plan.

Solution: Everybody makes mistakes. Nobody’s perfect. If you learn you made an error, the best thing to do is to take responsibility for it.

Let the beneficiary know what happened, apologize for your mistake, and ensure them you’ll do everything you can to make things right.

Call or email the carrier to let them know about the error. They may have a corrections form you can fill out. Depending on the carrier, they may even change the enrollment to the right plan retroactively.

6. New Medicare Agent Nervous About AEP

Scenario: This fall will be my first time selling during the Annual Enrollment Period (AEP). I want to be as prepared as possible to make it a good, profitable sales season.

Solution: We’re so excited for you and ready to help you find success! At Ritter, we have several resources, including eBooks and guides, blog posts, training videos, and podcast episodes related to Medicare sales and AEP preparation.

That’s a good place to start if you want to learn the basics, stay informed of market changes, and find new tips and strategies.

To make sure you’re contracted with the best health insurance plans and ready-to-sell, we recommend:

• Reviewing new Medicare Advantage First Looks when they become available in the summer
• Reading our latest Medicare Advantage Sales Contract Recommendations blog post
• Taking advantage of your free insurance portfolio review
• Bookmarking our Medicare Advantage & Part D Certification Info blog post. It gets republished every week in the summer with the latest carrier certification information!

If you want more tips or local market information, you can always reach out to our Sales team.

7. T65 Client on Disability Has Medicare Part A, Needs Part B

Scenario: I recently met with a client who’s been on disability (and receiving payments) for several years. He declined Medicare Part B when it first became available to him, but he took Part A. He’s turning 65 soon and would like to enroll in Part B.

Solution: Good news! Your client should be automatically enrolled in Medicare Part B when he turns 65. Even better… he shouldn’t have to pay a late enrollment fee for delaying this coverage!

If your client is eligible for Medicare due to a disability and is dropping job-based insurance that paid before Medicare, he may get an SEP — that lasts up to eight months — to enroll in Part B. Otherwise, he’ll likely have to wait for the General Enrollment Period to enroll in Part B and may face a penalty.

8. Clients with VA Benefits, TRICARE, or COBRA

Scenario: I’m slightly nervous about going to a Medicare sales appointment only to have a client tell me they have VA benefits, TRICARE, or COBRA coverage.

Solution: Did you know that two can be better than one with VA Benefits and Medicare?

If veterans with VA benefits pair them with a Medicare plan, they can have more flexibility and options in where they receive care and how it’s paid for. The same may also be true for people with TRICARE and COBRA, though this varies more based on the exact situation.

In general, when you’re helping clients like this…

1. Take a really good look at what their current coverage covers.
2. Consider if it would be advantageousfor them to enroll in some form of Medicare.

Some carriers even offer Medicare Advantage plans designed for veterans. If you have additional or market-specific questions, you can always check with our Sales team.

9. Client’s Contact Info Is Out of Date

Scenario: I want to follow up with a long-time client of mine, but I think they moved and changed their phone number.

Solution: Unfortunately, there’s not too much you can do, but you can try a few things:

• Send a letter to their old address and see if it gets forwarded to their new one
• See if the carrier can provide you with their contact info, though they aren’t obligated to do so — even if you are the agent of record
• Wait for the client to contact you
• In the future, try to make sure you record as much contact information as you can for a client, including an email address. Email addresses provide another way to connect with clients — one that doesn’t change if they move — and can help cut down on the amount of paper you use and its associated costs.

10. Compliantly Selling Other Products to Medicare Clients

Scenario: _ I’m also contracted to sell ancillary insurance products, but I’m not sure when I can or can’t offer these plans during Medicare sales appointments._

Solution: If your client has checked the proper box on the Scope of Appointment form, you can discuss that ancillary product during the Medicare sales appointment. Otherwise, the best time to cross-sell ancillary plans to your Medicare clients is after AEP, at follow-up appointments.

During AEP, you can schedule follow-up appointments with clients. For clients who don’t wish to schedule one at that time, try giving them a call a few months later to check in. While following up, you can:

• See how they like their plan
• Ask if they about their current coverage
• Inform them you can help them with any other coverage needs, like:
  • Dental, vision or hearing
  • Hospital indemnity
  • Life insurance
  • Final expense
  • Short-term care
  • Long-term care

You can also mail your clients letters or mailers about the additional types of plans available to them that may help to lower their out-of-pocket costs and cover what Medicare doesn’t cover.

Explore how to pitch ancillary products to Medicare clients more! Download our free guide

Medicare sales aren’t always going to be easy. You’ll probably get your fair (or maybe unfair) share of clients in a pickle, but we believe in you and your problem-solving abilities!

If you ever feel like you’ve bitten off more than you can chew or just want a second opinion on a tough case, we’re always just a phone call or message away!

Register with RitterIM.com to access our free sales tools and support today!