Knowing Medicare prescription drug plans for your clients are out there is one thing, but finding the right fit is another.
To understand how to compare Medicare Part D drug plans and how to pick a Medicare plan that makes sense for your clients, it’s important to know what makes a good prescription drug plan (PDP).
The key consideration is this: Will it cover your client’s drugs at an affordable cost? A low-cost plan premium with a preferred pharmacy right next door sounds sweet, until you learn the most expensive medication your client takes isn’t covered by the plan’s formulary.
How can you make sure you’re enrolling clients in affordable Medicare prescription coverage? Follow the four steps below.
1. Make Sure Your Portfolio Is Ready with Contract Now
Before you get to the actual sales appointment, you need to have prescription plans for Medicare in your portfolio. It’s always nice for your client to have options, so we recommend contracting for several Part D plans in your area.
How do you know which plans to add? Start with a portfolio review with your sales specialist. You can also speak with other insurance agents in your area and attend local carrier events to learn about options. Then, it’s time to contract.
Ritter’s Contract Now makes the process as easy as shopping online.
Ritter’s Contract Now makes the process as easy as shopping online. You’ll add plans to your cart, review and edit as necessary, and sign to complete each contract. You can even submit contracts that require wet signatures through Contract Now.
Note: Contract Now is only available to registered Ritter agents. If you’re newly registered, you must speak with your sales specialist to activate this feature.
2. Collect and Review Your Client’s Prescription Drug Info with PlanEnroll
Before your meeting with a client, collect a complete list of the prescription drugs they’re currently taking. It’s important to gather some specifics, including:
- The name of the drug
- Dosage
- Frequency it’s taken
- How often the client refills it
- Their preferred retail pharmacy
- If they’d like prescriptions delivered by mail
Getting the specifics right is particularly essential since that’s how a formulary for Medicare Part D will be organized. If your client doesn’t know these figures off the top of their head, they can generally find them by checking their prescription labels.
To help you keep track of your client’s prescription list and make the process of how to choose a Medicare drug plan much easier, we suggest securing your own free PlanEnroll site and MedicareCENTER account and utilizing the Client Sync feature.
Client Sync empowers your clients to enter in their own drug information.
When you invite your client to create their own profile through Client Sync, you’ll be able to see any updates they make on your side in MedicareCENTER. These updates include prescription drug information, pharmacies, doctors, and more! Save valuable time and effort and minimize mistakes when you invite your client to use Client Sync. (We recommend reviewing the prescriptions with your client to make sure they’ve entered in the correct information.)
3. Use MedicareCENTER to Compare the Available PDP Options with Your Client
Part D plans vary in a few key areas, and we mean it when we say there’s no such thing as “the best PDP” for any state or region. Every plan recommendation should depend on the specific needs of your client, so it’s important for you to consider all the variables when comparing plans.
Besides storing and tracking client medication info, MedicareCENTER makes comparing PDPs simple. When you run a quote for your client, this powerful tool pulls personal data from your client’s PlanEnroll profile (that they potentially entered themselves) and uses it to tailor estimates. You’re then able to recommend a plan based on more specific factors that are unique to them.
Additionally, apply plan search filters for drug, pharmacy, and doctor data as well as Medicaid status to streamline the process further.
Consider these three major factors that determine the quality of a PDP — its formulary, its premium and deductible costs, and its network of pharmacies.
Medicare Formulary
Carriers define what prescription drugs they’ll pay for by placing every drug into tiered formularies. Typically, the most expensive drugs are placed in higher tiers where the member is responsible for most of the cost, while lower-cost, generic drugs are placed in the first tier. In our opinion, a plan’s formulary is the single biggest factor in how affordable and sensible a drug plan really is for a client.
Here’s a breakdown of a common five-tier formulary:
Tip: If your client is taking one or more name-brand drugs, ask if they would consider taking a generic version to help lower costs.
Premium and Deductible
Monthly premiums for PDPs vary by state or region depending on the carrier offering the plan. Likewise, deductibles vary by carrier and by plan.
Some plans have a $0 deductible on all tiers (very few in 2025), while others have a $0 deductible only on select plan tiers (most commonly tiers 1 and 2). On the other hand, some plans have the maximum deductible allowed by CMS on all tiers, $545 for 2024 or $590 for 2025. The rest of the PDPs have deductibles that fall somewhere in the range of no deductible to the max. Just because a plan has a deductible, however, doesn’t mean it won’t be the lowest overall in cost for a client.
There’s no denying, though, that low-cost Medicare Part D plans are attractive. It may be hard to break a client’s “lowest-premium-wins” perspective, but it’s important to consider if they can truly afford the plan with the cheapest premium. It may not be a good fit for clients who don’t have the means to pay the deductible up front.
Fortunately, those who struggle to pay a large chunk up front for expensive medications now have the option to spread out payments into more manageable monthly amounts via the Medicare Prescription Payment Plan. Although the program doesn’t reduce overall out-of-pocket costs, it does eliminate the need to owe a big lump sum during one pharmacy visit.
Network
Similar to how health plans have hospital networks, PDPs have pharmacy networks that provide drugs at a reduced cost. If your clients have a local pharmacy they trust, you’ll want to consider PDPs that include it as an in-network — or even better, a preferred — pharmacy. Here’s why.
- In-network — Members can use their plan benefits at these pharmacies in the broad network established by the plan.
- Preferred — Members may receive even lower copay or coinsurance benefits for covered drugs at these pharmacies than at standard in-network pharmacies.
- Out-of-network — Members don’t have any benefit coverage at these pharmacies that aren’t in a plan or carrier’s network.
4. Recommend a Plan from Your Diverse Portfolio
You’ve made it this far, and clearly, you have a knack for PDP sales. After you’ve prepped your portfolio, gathered your client’s prescription drugs, run plan comparisons, and reviewed their available plan options, it’s time to do what you do best — make a recommendation and complete the sale!
If you have four different clients who each need a PDP, it’s completely possible that the proper recommendation could be a different plan for each. All it takes is a different location, fixed income, or prescription drug to drastically influence how a PDP fits a beneficiary. With that in mind, we suggest contracting to sell several available plans in your market or at the very least, performing regular portfolio reviews.
With the tips in this post and use of sales technology, you’ll be prepared to go out and close PDP sales. It’s important to note that you only gain access to our tools and resources by registering with us. It’s free and easy, with nothing to lose and so much to gain. So, complete your registration with Ritter and get another step closer to finding success in the PDP market!
Editor’s Note: This post was originally published in November 2018. It has been updated to include more relevant information to 2025.
Not affiliated with or endorsed by Medicare or any government agency.
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