Presenting Recommended Plans

We’ll begin our lesson on sales appointments with a quick disclaimer.

Requirements for planned presentations vary greatly from carrier to carrier. We’re going to cover some general guidelines, but you should always refer to a carrier’s specific processes before presenting their plans to clients. With that in mind, let’s talk about describing your recommended plans.

The purpose of a sales appointment is to make sure your client has all of the information they need to decide on the plan that’s right for them. This includes you covering everything from prescriptions, providers, to coverage and costs. We’ll look at providers first.

You’ll want to review your clients’ preferred doctors, hospitals, and specialists, noting whether they’re in or out of network. Your recommended plan should generally have their providers in network. And if they don’t, you want to make sure they’re aware and willing to make a change.

Second, review information about prescription coverage. Are there prescriptions covered under the formulary? You should review under which tier each of their prescriptions falls so that they understand the associated costs.

You can use consumer-facing sites like Medicare.gov or the carrier’s website to review this information with your clients. Additionally, ask about their preferred pharmacy and confirm that the pharmacy is in network. If it isn’t, you’ll want to make sure they understand how that impacts their costs and see if they’d be willing to make a change.

As with providers, your plan recommendations should already factor in your client’s prescriptions. If the formulary does not include coverage for one of their prescriptions, explain how that will impact costs and how they could lower their expenses.

We’ll lump coverage and cost together since these go hand in hand. Take some time to review the services covered and the associated costs. Also, ask your clients what services they’re most concerned about so you can ensure that these are covered.

As you review these items, make sure to explain the premiums, the out-of-pocket costs, and any additional services provided by the plan.

You’re covering a lot of information with these clients. Make sure you’re speaking slowly, allowing time for questions, and offering clarifications along the way.

Three final notes as we wrap up this lesson. First, as you’re providing all these details, make sure you point your clients in the right direction for more info as they need it. For example, the evidence of coverage is a great place to point them if they want more details about how their coverage works. You’ll also wanna make sure they know where to find that provider and pharmacy directory.

Second, remember that these are just general guidelines. You should always review and follow a carrier-specific sales appointment process.

Third, CMS does require agents to cover a lot of information with clients. This is to make sure that both you and the sales appointment remain compliant. You can always review these requirements and best practices in our MA and PDP Compliant Sales Checklist.

Of course, once you’ve successfully presented your recommended plans to your client, they’re ready to make their choice and enroll. Head on over to our next lesson where we’ll cover this process.

Mentioned in this Lesson:

MA & PDP Compliant Sales Checklist
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