Idea: automatic switching medicare advantage

[rmhaire]

In the US, utilities are regulated at the state level . . . most of Medicare regulation occurs at the federal level. More corruption and bureaucracy to deal with . . .

Yep. What Somarco said.

You're confusing access to carrier info with CMS. All of the MA quote engines get their plans and rates from the carriers. Not CMS. And all of that has to be pre approved by CMS.

You're talking about getting client info, premiums and other info from all the carriers. Since carriers don't share that information, the only other place you could get it from CMS. And they're not about to give that up.

Your idea might work with auto or homeowners. But with MA, you're beating a dead horse.

 

[sshafran]

For PDP's -- I've mostly gone "hybrid" between really working to make sure they're good and understand the reason for the change, & not helping at all. Let me explain.

Some agents are now refusing to do PDP reviews. It's a time killer. There are bigger fish to fry and we're running a business. They'll simply say, "here's my sunfire link if you want to shop. Or, here's an overview of the plans - do the research & pick one." I don't want to go that far away from assisting.

So, hybrid.

Last year during AEP, I still gathered updated Rx lists and compared it to S&S and made recommendations - but I kept it short and sweet.

"Hey John, based on your Rx's, it looks like WellCare Classic would make sense for 2023 - I'm sending you a link to enroll the e-mail will say, "2023 Medicare Health Plans - Plans of Interest" You can click on that link and enroll for 2023. I followed that up with a text - "I just sent you an e-mail for Part D for 2023 - please take a look w/ the plan I'm recommending"

If they ask questions, I send them the summary of benefits and let them know what tiers the meds are. That's it. Tier list, summary of benefits.

It's not 100% hands off but it is quicker, and I don't really have the time (nor the desire to take the time) to go over every reason in my brain for the recommendation.

Most listened and changed based on what I recommended. Some asked questions but most did not.

If they don't change, then get mad at me because Eliquis went to Tier 4 - well, John, I told you Classic looked good...

The problem with your model is you want the computer to figure it out for MAPD. I think a computer could do a decent job with a PDP. But not with MAPD - that takes a little more brain power in my opinion.

 

[sshafran]

PS - I wish there were a way we could just auto-switch their PDPs. The issue would be liability; I don't want that. But, frankly, it would make life easier if they sign some form that says, "we agree to provide an accurate Rx list to Scott - and we allow him to pick a PDP plan and process the application, and we understand that no PDP plan is perfect but he's acting in good faith and we can't complain."

 

[somarco]

"here's my sunfire link if you want to shop. Or, here's an overview of the plans - do the research & pick one." I don't want to go that far away from assisting.

Neither do I . . .

Mcare.gov has been such a disaster for several years that I have given up on it ever coming back. S&S is much improved from the early days but it seems to have become really sluggish as they added on other pieces.

Some of my clients have tried doing it themselves because they know I am swamped. A few will run the report on Mecare.gov and send me a copy of the printout to review. That works pretty well, especially since they initiated it, not me.

And some have jumped right in, run their own comparison, and signed up . . . only to later regret it, often because they failed to note the preferred pharm is not the same as last year.

I know I go overboard on a lot of things that are not always productive, but it is also the thing that develops a sense of loyalty.

 

[Yanster]

For PDP's -- I've mostly gone "hybrid" between really working to make sure they're good and understand the reason for the change, & not helping at all. Let me explain.

Some agents are now refusing to do PDP reviews. It's a time killer. There are bigger fish to fry and we're running a business. They'll simply say, "here's my sunfire link if you want to shop. Or, here's an overview of the plans - do the research & pick one." I don't want to go that far away from assisting.

So, hybrid.

Last year during AEP, I still gathered updated Rx lists and compared it to S&S and made recommendations - but I kept it short and sweet.

"Hey John, based on your Rx's, it looks like WellCare Classic would make sense for 2023 - I'm sending you a link to enroll the e-mail will say, "2023 Medicare Health Plans - Plans of Interest" You can click on that link and enroll for 2023. I followed that up with a text - "I just sent you an e-mail for Part D for 2023 - please take a look w/ the plan I'm recommending"

If they ask questions, I send them the summary of benefits and let them know what tiers the meds are. That's it. Tier list, summary of benefits.

It's not 100% hands off but it is quicker, and I don't really have the time (nor the desire to take the time) to go over every reason in my brain for the recommendation.

Most listened and changed based on what I recommended. Some asked questions but most did not.

If they don't change, then get mad at me because Eliquis went to Tier 4 - well, John, I told you Classic looked good...

The problem with your model is you want the computer to figure it out for MAPD. I think a computer could do a decent job with a PDP. But not with MAPD - that takes a little more brain power in my opinion.

Very interesting, thank you! Could you elaborate on why PDP reviews are a time killer? Is it because the customer has to provide an up to date medicine list? Or is it because you have to look at the changes of the current plan and subsequently manually re rate in order to see if there are better options?

The above process sounds like it could be automated pretty easily. What if we make the switch 'semi-automatic'. --> We will gather the updated Rx lists from the customer by automated mail flows. This will be used as input for the (automated) re rate (in S&S?). The 'best' plan will be automatically send to the customer. He / she can then accept the new plan with one click.

This way you automate practically every step, without the liability. What do you think?

Last question, you are talking about S&S. I'm not familiar with this party. Is this a quoting engine that you use for PDP? Could you please provide me with a link?

Thanks!

 

[sman]

Very interesting, thank you! Could you elaborate on why PDP reviews are a time killer? Is it because the customer has to provide an up to date medicine list? Or is it because you have to look at the changes of the current plan and subsequently manually re rate in order to see if there are better options?

The above process sounds like it could be automated pretty easily. What if we make the switch 'semi-automatic'. --> We will gather the updated Rx lists from the customer by automated mail flows. This will be used as input for the (automated) re rate (in S&S?). The 'best' plan will be automatically send to the customer. He / she can then accept the new plan with one click.

This way you automate practically every step, without the liability. What do you think?

Last question, you are talking about S&S. I'm not familiar with this party. Is this a quoting engine that you use for PDP? Could you please provide me with a link?

Thanks!

The biggest issue with PDP comparisons is the amount we get paid in relation to the time it takes. However, many of us do it as a service to our clients as it adds value.

The S&S system is Search and Save. It allows for the input of medications and pharmacies to run a comparison of all available PDP's. It too has an option whereby existing clients receive an email to update their previously entered medication lists. For potential clients, we can provide them with a link they can use to enter their medications and pharmacy so we don't have to do it. But here's the problem, the client/prospect sometimes gets it wrong. They choose a capsule when they are taking a tablet (or vice-versa), they enter the brand name when they are in fact taking the generic, they get quantity limits wrong, etc. So we still have to review to make sure the info is correct.

If you can figure out a new way to invent the wheel and eliminate mistakes, more power to you.

 

[somarco]

If you can figure out a new way to invent the wheel and eliminate mistakes, more power to you.