Assessing Needs to Recommend a Plan
Learning to Sell | Lesson 8

Tying It All Together

There is a lot to consider when choosing a health plan.

That’s why your role as an insurance advisor to your client is so important!

In this lesson, we want to look at common considerations like cost, coverage, and provider access to identify which plans appeal to different preferences.

Let’s start with cost.

Here we can look at two factors — premium and out-of-pocket cost.

If you are working with a client that would prefer to avoid high premiums, either Original Medicare or a Medicare Advantage plan could be a great fit.

Of course, these two options will have out-of-pocket exposure as the beneficiary uses their health services — especially Original Medicare, which does not have a maximum out-of-pocket limit like MA plans do.

If you’re working with a client that would prefer to limit their out-of-pocket exposure, a Medicare Supplement might be a good product for them.

However, Medicare Supplement will have higher premiums compared to Medicare Advantage options.

Next, let’s look at coverage.

If your client prefers to keep all their coverage in one plan, that client should consider Medicare Advantage.

MA products combine Original Medicare, Parts A and B, and usually include Part D all in one product.

Many plans also include other valuable supplemental coverage, like dental benefits, in their plan as well.

Compare that to Original Medicare or a Medicare Supplement, where your client will need to purchase separate products, like Part D or dental, to fill coverage gaps.

Lastly, we need to review provider access.

Does your client travel often? Do they value flexibility in providers they can see?

If so, Original Medicare or a Medicare Supplement might meet that need.

Both options allow a beneficiary to see any provider that accepts Medicare’s payment rules, which most of them do.

While Medicare Advantage plans will narrow access to the providers in the network, preferred provider organizations (PPOs) and Medicare Medical Savings Accounts can offer broader provider access in an MA plan.

Hopefully this overview has helped tie some of these concepts together.

Keep in mind that it is not always a clear decision. You may have a client who would like the out-of-pocket protection of a Medicare Supplement, but also wants the lower premium of a Medicare Advantage plan.

Here, your role as an advisor is to help them prioritize their preferences and help them identify which plan would likely result in a better outcome based on the results of your fact-finding.

Essentially — you want to help them decide which of the different factors is most important to them.

And of course, always put your clients first.

Getting to know their personal needs and preferences and recommending a product that adequately meets those needs will set you up with satisfied clients and an expanding book of business.

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