Assessing Needs to Recommend a Plan
Learning to Sell | Lesson 2

Client Eligibility

Reviewing your client’s eligibility for various products is a great place to start when finding the right plan.

After all, if they don’t qualify for a plan, it doesn’t matter if it checks all the other boxes for them.

When it comes to determining their eligibility for these products, you’ll want to do a bit of fact-finding.

To start, you’ll want to find out a bit more about their Medicare status.

Have they enrolled in Original Medicare? Do they have Parts A and B? What is the effective date of that coverage?

These questions will help you determine their eligibility for different Medicare insurance options.

For example, if they only have Part A or Part B, they’ll qualify for Medicare Part D, but not Medicare Advantage or Medicare Supplement. On the other hand, someone who has Part A and Part B, could qualify for all three of those options.

Next, you’ll want to identify their enrollment opportunities for those products.

This is where finding out the effective date of their Medicare coverage comes in.

This can help you identify if they are in their Initial Election Period for Medicare Advantage or a prescription drug plan.

Similarly, this can reveal if they are still in their Medicare Supplement Open Enrollment Period.

Keep in mind, certain products, like MA and PDP, require your client to be in an eligible enrollment period to sign up. So, checking on this early helps you narrow down the options from the start.

That being said, don’t take MA and PDP off the table if your client is outside of their Initial Enrollment Period.

They may have other opportunities to enroll, like the Annual Enrollment Period or a Special Enrollment Period.

Lastly, review if there are any factors that would disqualify them from joining a certain plan.

For example, it is illegal to sell someone a Medicare Supplement if you know that client also has Medicaid — so that’s one combination you need to avoid.

Once you’ve figured out what options are available to your client, it’s time to dig in and learn more about what they are looking for in a plan.

Head over to the next lesson to learn more!

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