How to Help Medicare Clients in Poor Health Choose the Right Coverage

When you meet a new Medicare client with a serious health condition or a hefty prescription drug history, finding the right coverage is key for their health and your book of business.

They may not be able to switch plans down the line. It’s vital to set them up with the best possible coverage for now and in the future. But, how?

Just as you always do, you’ll want to help them figure out if they should enroll in a Medicare Advantage plan or stick with Original Medicare and purchase a Medicare Supplement (and Part D plan). Then, you’ll want to recommend the best carriers and plans for their budget and needs.

Is Medicare Advantage or Medicare Supplement Better If You’re Sick?

The age-old question: Medicare Advantage (MA) or Medicare Supplement (Med Supp)? Both types of coverage have their time and place. And, both can be great options, depending on the individual and their needs and preferences.

Ultimately, it comes down to your individual client, their health and prescription drug needs, and budget to determine which is best for them.

Ultimately, it comes down to your individual client, their health and prescription drug needs, and budget to determine which is best for them.

There are times when someone with a serious health condition may be better off in an MA plan, even though these plans can have restrictive networks. However, many times, people in poorer health can thrive with Original Medicare, a Med Supp, and Part D coverage.

If the monthly premium on the Medicare Supplement plan is affordable, it will allow the client to see any doctor that accepts Medicare and with a plan G they will not have to worry about the cost of individual visits or treatments.

This may be a huge savings compared to a potential Maximum out of Pocket (MOOP) from many MA plans. However, if the client is of limited means, they may be able to get financial assistance from their providers and therefore not have to worry about the MOOP with the MA plan option.

Chronic Condition Special Needs Plans

If your client has a chronic illness, they may qualify for a special type of MA plan called a Chronic Condition Special Needs Plan (C-SNP). These plans offer all the usual benefits of MA plans and more.

C-SNPs are usually customized based on the condition(s) they cover. For example, they may offer those with the condition access to specialists in network or more coverage for medications that treat their illness. These extra benefits could make the plan worthwhile for your client to enroll in.

Learn more about selling C-SNPs Download our free guide,The Guide to Prospecting and Selling C-SNPs to meet the needs of those with chronic health conditions!

Med Supps for People in Ill Health

Many people sign up for MA plans when they turn 65, maybe because they’re healthy, and the coverage is affordable and convenient (i.e., their dental, vision, hearing, medical, and even prescription benefits are all in one plan).

But, according to a 2017 study, when they fall ill, many Medicare Advantage members may leave their plan to go back to Original Medicare so they can access and afford better care.

When they fall ill, many Medicare Advantage members may leave their plan to go back to Original Medicare so they can access and afford better care.

A Medicare Supplement, may allow clients to:

• Better budget their out-of-pocket expenses
• Access to any Medicare provider across the U.S. that accepts Medicare assignment

It’s important to remember that, without having a guaranteed issue right, your client may have to pass underwriting to get into the Medicare Supplement plan they want.

People aging into Medicare have a guaranteed issue right in their Med Supp Open Enrollment Period; otherwise, these rights are available in specific circumstances. If your client is ill, it could be valuable for them to get a Med Supp from the start.

Additional Insurance Considerations for Clients Who Are Sick

Once you’ve helped your client figure out if they’ll be looking for a Medicare Advantage or Medicare Supplement plan, it’s time to help them narrow down their carrier and plan options.

We recommend keeping an eye out for the following. These deatures can all point toward more stable premiums and cost-sharing in the future.

• Carriers/plans with a long, positive financial histories
• Companies with an established and positive record of service for their membership
• Plans that don’t accept guaranteed issue business (if you’ve recommended a Med Supp)

If your client is interested in a Med Supp plan, remember that prices can vary greatly, even in the same area, but same-lettered plans provide the same basic benefits due to their standardization across 47 U.S. states.

Keep in mind, the most expensive services for MA members are infusions/injectables, cancer treatment, and hospital stays (the most likely ways to hit the MOOP), so if their illness is likely to involve those things, a Med Supp may be the wise choice.

If your client’s rates seem to get too high, know that you may be able to help them get into a plan with a lower rate by utilizing their Medicare Advantage trial period.

Lastly, don’t forget the cost protection that ancillary insurance may be able to provide to sick Medicare clients.

• Hospital indemnity insurance can cover out-of-pocket costs associated with Medicare Advantage plans.
• Critical illness plans can provide peace of mind for those with a family history of cardiovascular disease or cancer.

The Centers for Disease Control and Prevention report that 75 percent of American adults have at least one chronic disease while 50 percent have two or more chronic diseases. Among adults age 65 and older, 90 percent have at least one chronic condition!

As a health insurance agent, it’s likely you’ll meet several individuals with serious health issues looking for Medicare coverage. Be sure to take all of the information discussed above into account while attempting to help them find the right coverage for their unique situations.