It’s that time of year again. The Annual Enrollment Period (AEP) has come and gone, and the Medicare Advantage Open Enrollment Period (OEP) is here. How can you make the most of this Special Election Period (SEP)? By selling prescription drug plans (PDPs).
During AEP, your clients may decide to enroll in a private health plan. But, with their high out-of-pocket exposure and network restrictions, beneficiaries sometimes find that their new Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plan is not the right fit. If these beneficiaries are new to Medicare and enrolled in an MA plan during their Initial Coverage Election Period (ICEP), they can switch back to Original Medicare during the MA OEP, which runs from January 1 to March 31.
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If they make the switch, your clients can pick up a Medicare Supplement plan, which has less out-of-pocket exposure and no networks, to fill in their coverage gaps. However, they will also need to join a PDP in order to avoid paying a penalty for not having prescription drug coverage and to cut down the costs of their prescription drugs. That’s where you come in.
By selling PDPs during the MA OEP, you can help your clients get the coverage they need. Beneficiaries can only change PDPs during their initial enrollment period, AEP, the MA OEP, or an SEP. If your client goes without creditable drug coverage for any continuous period of 63 days or more after their initial enrollment period is over, they may be required to pay a penalty. That’s why even clients who don’t take prescription drugs may require your help.
Selling PDPs follows the same CMS guidelines as MA plans. Scope of Appointments are required, and to sell PDPs, agents must complete Part D certification for each carrier that they wish to sell through. Certification requirements vary by carrier.
Don’t want to go through another certification process? Some carriers offer a referral program contracting option that does not require certification. Under the referral program, agents don’t sell PDPs—they refer their clients directly to the carrier to enroll. For their service, agents will generally receive a one-time payment for each referral.
Shopping around for PDPs can be frustrating for shoppers, and they could potentially enroll in a plan that does not meet all of their needs. The need for drug coverage differs among shoppers because it depends on the clients’ prescription drugs. Additionally, coverage options vary by carrier and service area. Agents like you can help beneficiaries sift through their options.
Running a PDP quote is as simple as utilizing carriers’ PDP quoting tools or visiting Medicare.gov. Though, keep in mind that carriers post changes to their formularies immediately, ensuring their quote engines contain the most up-to-date information. It takes more time for Medicare.gov to update their information since they must receive the changes from the carriers and then post them.
PDPs lower the cost of current and future drugs your clients’ doctors may prescribe and offer beneficiaries peace of mind. If your client is in need of Part D coverage and you don’t offer it, another agent may come to their aid. Be a one-stop shop for your clients. Protect your business by making sure you have a PDP in your portfolio.
Not affiliated with or endorsed by Medicare or any government agency.
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