Presenting Recommended Plans

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

Requirements for sales presentations and what must be covered vary from carrier to carrier. We’re providing some general guidelines here, but you should refer to the carrier’s required processes before discussing their plans with clients.

With that disclaimer out of the way, let’s talk about describing your recommended plans.

The purpose of a sales appointment is to ensure that your client has all the necessary information to decide on the plan that’s right for them.

This requires you to cover information about their providers, prescriptions, coverage, and costs.

We’ll look at providers first.

Here you’ll want to review your client’s preferred doctors, hospitals, and specialists with them, noting the in- and out-of-network status of those providers.

Your recommended plans should generally have most of their providers in the network. If any providers are out-of-network, be sure your client is aware and make sure they’re OK with making that change.

Second, review information about prescription coverage.

Are their current prescriptions covered in the formulary? Find out what tier those drugs would fall under so your client understands the associated out-of-pocket costs.

You can use consumer-facing sites like Medicare.gov or the carrier’s website to review these details with clients.

Additionally, ask about their preferred pharmacy and confirm that the pharmacy is in the plan’s network.

If their preferred pharmacy is not in-network, ensure your client understands how that impacts cost and see if they’d like to make a change.

As with providers, your recommended products should already factor in your client’s prescriptions. If any prescriptions are not covered, explain how that impacts cost and how your client could lower those expenses.

We’ll lump coverage and cost together since these go hand in hand.

Take some time to review what services are covered and the associated cost for those services.

Also, ask your client if there are any specific services they want to ensure are covered.

When reviewing these items, make sure you cover premiums and out-of-pocket costs along with any supplemental benefits offered by the plan.

Looking for tools to help with your sales appointment?

Ritter’s Shop & Enroll platform enables you to easily review covered services and costs. You can even compare those benefits side-by-side for up to three plans. It’s a great tool to use during client meetings to show the nuanced differences between plans.

And speaking of nuance, remember, you’ll be covering a lot of information during your sales appointment. Make sure you’re going at a pace the client can follow, pausing for questions and offering clarifications.

Three final notes to wrap up this lesson.

First, as you review these details, educate your clients about where they can find additional information.

Point them to their evidence of coverage for details about covered services and ensure they know where to find the provider and pharmacy directory.

Second, remember these are just general guidelines. Always review and follow the carrier’s required sales practices when discussing a plan.

Third, CMS requires agents to cover a lot of information with clients for you and the sales appointment to be compliant.

You can review these requirements and best practices in our Compliant Medicare Advantage Sales Appointment Checklist.

Of course, once you’ve successfully presented the recommended plans your client will be ready to make their choice and enroll!

We’ll review this process in the next lesson.

Mentioned in this Lesson:

MA & PDP Compliant Sales Checklist
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