• Growing Your Business During Lock-In

    During the annual election period (AEP) those on Medicare are actively searching for agents to help them enroll onto Medicare plans so it’s far easier to grow your book of business. But what about the other 10 months of the year? Here are some tips to help grow your business all year round.

    Visit Local Doctor’s Office – Going around to local doctor’s offices and introducing yourself could potentially get you referrals. Make sure to bring business cards or flyers to leave behind. Often clients talk to their physicians or doctors’ offices for guidance on insurance. This is especially true for clients who have formed a relationship with their doctor over the years. Knowing the doctor’s offices in your area and making yourself known to them could potentially be an easy way to gain more clients.

    Invest in Leads – Ordering leads is a simple way to open yourself up to new markets, make new contacts and gain more business. There are various lead types to choose from based on your budget. Internet leads tend to be pricier but usually mean the client is actively searching for information. Mail drop leads are much cheaper but the return rate is only around 1-2%. Also, since leads are generated by people actively looking for information on health coverage, it is important to act fast on leads. Acting fast will ensure the client doesn’t go looking for information elsewhere and helps you to get the sale.

    Pay attention to trainings year round – Many companies offer training or informational classes throughout the year to discuss how they can help you grow your business during lock-in. Take advantage of these opportunities and hear what they have to say. Although their suggestions could be tips you already know about, they could also be offering support that could help you toward your goals that you wouldn’t get on your own.

    Have (and know) the right products to sell – Make sure you’re contracted with the right products to help bring you more business outside of AEP. Developing a relationship with a client by starting out with life products could potentially lead to them coming to you for health insurance in later years. Medicare supplement plans are also key to helping grow business during lock-in. This is especially true in states such as California where the birthday rule applies.

    Run meetings within your area – When a person first enters into Medicare it can be difficult for them to navigate the system. Hearing about the various plans can seem confusing and frustrating so having someone on their side who can competently explain their insurance options can drastically ease their worries. Holding meetings throughout your community or service area can help build relationships that lead to sales and referrals. It also helps you become a staple within the community so people know who to go to when they’re ready for help with their insurance needs.

  • What to Know About Specialty Drugs

    Recent advances in the pharmaceutical industry have brought major innovations to the treatment of diseases like cancer, rheumatoid arthritis, and hepatitis B. New medications can offer hope and better quality of life to patients struggling with life threatening or chronic conditions, but these drugs come at a high cost and can be a burden even for people with coverage through a Medicare Advantage or stand-alone Prescription Drug Plan.

    Here are some important considerations for clients who may need these new and advanced drugs.

    CMS allows plans to include a specialty tier in their formulary – Plans are allowed to place any drugs with a monthly cost over $600 on a specialty tier. This tier is not restricted to the usual 25% maximum cost sharing, so a member may be expected to pay up to 33% of the cost for drugs in this tier.

    Only a small number of drugs are in most plan’s specialty tires – On average, less than 10% of the drugs in the CMS reference formulary are included in a plan’s specialty tier. Just because a drug is new does not necessarily mean it won’t be covered at a lower tier. The specialty designation is generally reserved for the most expensive drugs used by the smallest group of people.

    Part B vs Part D covered drugs – Some drugs can be covered under either Part B or Part D, depending on how and where they’re administered and how they’re prescribed. As a general rule, drugs administered in a doctor’s office or other outpatient facility are covered under Part B, while drugs administered by the patient at home are covered by Part D. However, there are exceptions that can have a significant impact on what a patient pays for the same treatment. For example, oral chemotherapy drugs used in place of traditional infusion chemotherapy are covered by Part B, even if the patient takes them on their own at home. Other oral cancer drugs that could not alternatively be given via IV or injection in a doctor’s office are covered only under Part D. For a client with most Medicare Supplements, this can mean the difference between having no out of pocket cost once Original Medicare pays their 80% and their Medicare Supplement covers the remaining 20%, and paying up to 33% of the thousands of dollars that the drug could cost under Part D. In contrast, a patient with only Original Medicare and a Part D plan may save money with the Part D covered drug over the full course of their treatment, because Original Medicare does not have the out-of-pocket maximum that their Part D plan does.

    The coverage gap – For clients taking Part D specialty drugs, they will likely quickly become familiar with the coverage gap. Once they have exhausted their initial coverage, it’s important that they continue to show their Part D membership card when filling prescriptions, even if they’re paying out-of-pocket. This will allow them to access the manufacturer discount offered while in the gap and will help make sure that their out-of-pocket cost is tracked correctly to get them into catastrophic coverage as quickly as possible.

    There are programs to help cover the cost – Clients who even might be eligible for the Low Income Subsidy (LIS), also called Extra Help, should apply. Especially for those taking specialty drugs, the subsidy can save someonethousands of dollars a year. For people whose income is too high to qualify for LIS, there are manufacturer patient assistance programs from many drug companies. These programs can offer significant discounts, even completely covering the cost of a drug. Typically clients can apply on the manufacturer’s website and will be sent a card to use at the pharmacy to access the discount. If clients are not able to get LIS or help from their drug’s manufacturer, there are various charity programs designed to help people with high medical costs.

    Clinical trials have their own rules for Medicare Advantage plans – Members wishing to enter a clinical trial for a new treatment for their disease can do so while remaining in their Medicare Advantage plan and paying fee-for-service costs for clinical trial care. Their Medicare Advantage plan is required to continue to cover necessary treatment for their condition even while in the trial. Any cost sharing paid by a member for a clinical trial also must be counted towards their in-network out-of-pocket maximum by their Medicare Advantage plan.

    Dealing with a life threatening or chronic illness is difficult enough. Be prepared to arm your clients with this information to help make their treatment a little bit easier.

  • Proactive vs Reactive: The Importance of Contracting Before it’s too Late

    During the weeks before Annual Election Period there is a spike in the number of agents contracting with new carriers. But why wait until the busiest time of the year to contract? Why not have the tools you need to insure you’re prepared for each client all year round? Here are just a few reasons to contract now:

    Be Proficient – First off, ask yourself if you are currently confident with all of the products you have to offer a client. Are you prepared if you receive a call from a referral that is in a neighboring town outside your usual area? Don’t be caught without the most competitive plans in not only your direct area, but surrounding areas as well. The most competitive plan in one zip code can be drastically different in the next. When you’re missing something from your “tool bag,” clients can become uneasy about your ability to write the policy that best fits their needs. You might also miss out on referrals that could otherwise help grow your book of business.

    Be Prepared – Having the right materials and information for a company can be crucial to making the right sale. Applications and promotional materials can take a while to arrive. The same goes for properly registering sales events and advertising materials. Contracting early allows you to have these supplies sooner and on hand when needed.

    Stop Losing Sales – Clients often hear of health insurance plans from commercials or through their friends and they’re suddenly set on having that specific product. No other product will do in their minds. This happens more and more often. Advertising is effective and friend’s opinions matter. Just because you personally think that another plan might be better doesn’t mean your client will be set on that product. Offering more options opens up more opportunities.

    Don’t Scramble – Clients need to feel like you have a handle on their insurance needs. Waiting until a client requests a company and then starting the contracting process is an easy way to lose a client. Especially if they’re a new client and don’t have long until their enrollment period ends. You don’t want to have to refer your client to another agent and lose a potential sale.

    Know Your Contract – While keeping everything else listed above in mind, it’s also important to know your limitations or if it’s time to rework your contracts. Know the difference between being a captive agent, career agent and a broker and contract in the way that makes the most sense to you. Captive agents can only sell the products from the company they are employed by, while a career agent can offer other products but only after first offering the products from the company they work with. Brokers, on the other hand, are not chained down. They are able to sell any product that they are successfully appointed and certified with, ensuring they have a wide range of products to cover their client’s needs including unexpected referrals.

    For more information on what companies are available and contracting in general, please visit or contact contracting at

  • Does Your Client’s Doctor “Take Medicare?” What Does That Really Mean?

    Often people say that a certain doctor or other medical provider “takes Medicare,” but it’s not an accurate description of a doctor’s contract status with Medicare. There are actually three distinct categories of provider when it comes to Medicare, each with their own potential costs and limitations for clients.

    – A participating provider is one that agrees to accept assignment of Medicare benefits and can charge no more than the Medicare fee schedule amount for any services.
    – Clients will not be liable for excess charges, even without a Medicare Supplement plan that would cover them.
    96% of providers who offer services that Medicare would cover are participating providers.

    – Non-participating providers can choose to accept Medicare assignment on a per-service basis. If they accept assignment for a particular service, they can bill Medicare directly and the member will pay no more than their usual cost-sharing.
    – If they choose not to accept assignment for a service, the client is liable for excess charges and may need to pay up front and wait for reimbursement from Medicare for the covered amount. Excess charges are limited to 9.25% of the Medicare approved amount for a service, in addition to whatever the member’s usual cost-sharing would be. You can check our post on excess charges for more details.

    Opted out
    – Providers who have opted out cannot accept reimbursement from Medicare and must enter into a private agreement with their patients.
    – Patients will sign a contract with the provider agreeing to that provider’s fees and policies.
    – Patients who see a psychiatrist should be especially aware of the limitations for providers who have opted out. While only 4% of providers nationwide have opted out, 42% of those are psychiatrists.
    – Medicare Supplement plans will not pay anything towards services from a provider who has opted out.

    Knowing the difference between participating, non-participating, and opted out providers can save your clients money and headaches!