Medicare Advantage Network changes?

jasperjohns

Super Genius
198
Florida
Just curious how a MA agent keeps up with changes to plans in ones area. So for example if a agent offers 3 MA plans but the area has 6 popular plans and the plans the agent does not use have a major change that is not ideal for members- how does one get updated on this? Since those are not plans you offer the companies wouldn't alert the unaffiliated agent of these changes. Do high producing MA agents need to work with all the plans available to stay abreast of plan changes or is there way to research competing plans (or the ones you don't offer)?
 
I attend the FMO and individual carrier kickoff meetings every fall then during slow season for DSNP trainings. Be sure to pick up the carrier plan highlight guides and stick them in a binder.

Another reason to attend the meetings is you learn which carriers don't pay commission in certain counties. It's no secret UHC doesn't pay on MAPD in Philadelphia County, so why write business there?

Two weeks ago a smooth-talking out-of-state shyster broker called looking for an "agent manager" for his 22 Philly agents. He claimed to be writing business in OH, IL and IN and was too busy to fly out here. I told him I work in the suburbs mainly and am not a fan of Philly. As we chatted, I asked how his agents did during AEP in the City. He said they killed it with DSNPs in low income buildings there. I asked what carriers they used, and when he mentioned UHC, I asked if his agents liked working for free. He asked what's that supposed to mean? And I said well, if you knew the area you'd know they don't pay commission there - who is your upline? Needless to say, he muttered something about doing his research, hurried me off the phone, and would call me back that Monday.... It's been two weeks and I haven't heard a peep! Bet there are some agents in Philly who are livid right now they aren't getting paid!

I'm appointed to sell both Highmark Blue Cross and UPMC (both in PA). They are having major knockout, dragdown hospital network issues on the other side of the state from me. One of my FMOs keeps me posted, plus they each send occasional emails defending their positions.
 
I make sure to know my carriers' network issues as well as possible at the beginning of every plan year. All of the ones I'm appointed with have an easy online doctor search tool, and it's worthwhile to invest a little time getting familiar with the more popular providers. Those search tools are available to anyone, so even if you're not appointed then you could still look up the more relevant providers in a given area. That would be more difficult of course if you're in a call center talking to prospects in areas you don't have a clue about. Anyway network changes can happen throughout the year too, so even knowing the doctor list isn't fool-proof. I try to make sure all of my clients know to call me or check online if doctors are in network before they go. I tell them I don't mind checking for them, and I do actually get calls once in a while from some of them to look up a doctor. Providers can go in and out of networks at any time so it's quite frankly a moving target. The safest thing is to make sure your clients know to check the network before going to a new doctor. Then you have less you-know-what hitting the fan when one of your clients goes to an out of network specialist by accident.
 
I carry every MAPD plan here expect Florida blue (captive only)

It’s not tough to keep up with the changes. And you’ll have 2-3 companies that you prefer to write.
 
This is all excellent advice. Thanks to all.

One quick thing I would add is if you're going to be involved in Part C Advantage plans (and PDPs, for that matter), I would contract with every plan offered anywhere close to you.

There are lots of your competitor agents running around who only have one or two carriers, and if you have all of them to shop through, it'll give you a considerable advantage over them. I don't know how many times I've been sitting in someone's home and they had already seen another agent who could not help them because the only plan their doctor-whom-they-refuse-to-leave, pain clinic, or whatever, was non-par in their limited portfolio. Many of these agents are just too lazy to go through all the training and certifications every year with all those carriers. That's great -- more business for those of us who do have them.

I know it's a pain to have 8 or 10 carriers to keep track of, each with several different plans, but it's worth it. The key is to be organized. My car trunk is crammed with banker's boxes packed with dozens of different plans' enrollment kits, findable in 10 seconds or less since they're all sorted and labeled.

If you follow this advice, here's one more thing to make life easy for you. Every fall I download every single plan's SOB, EOC, star rating, formulary and provider directory (where available) and keep them on my laptop's HD. That way I can pull any of them up in seconds and answer questions, check doctors, and the like. That way if you're in a place where the internet hasn't been invented yet, you still have a resource that could save you from making a return trip -- or losing a sale.

As to PDPs, a lot of agents don't fool with them due to the high maintenance and puny compensation. That is a huge mistake, IMVHO. Even if you drive 50 miles and end up with nothing but a SilverScript PDP enrollment, for example, if you treat them right, they may well give you referrals for more profitable sales (life insurance, annuities, MAPDs, etc.). I have gotten to the point where at least 25% of my business is referrals, and there's nothing better than "free leads," which is precisely what referrals are.

Everyone on here has his own business plan, but that is what works for me. Good luck.
 
One quick thing I would add is if you're going to be involved in Part C Advantage plans (and PDPs, for that matter), I would contract with every plan offered anywhere close to you.

There are lots of your competitor agents running around who only have one or two carriers, and if you have all of them to shop through, it'll give you a considerable advantage over them. I don't know how many times I've been sitting in someone's home and they had already seen another agent who could not help them because the only plan their doctor-whom-they-refuse-to-leave, pain clinic, or whatever, was non-par in their limited portfolio. Many of these agents are just too lazy to go through all the training and certifications every year with all those carriers. That's great -- more business for those of us who do have them.

I know it's a pain to have 8 or 10 carriers to keep track of, each with several different plans, but it's worth it. The key is to be organized. My car trunk is crammed with banker's boxes packed with dozens of different plans' enrollment kits, findable in 10 seconds or less since they're all sorted and labeled.

If you follow this advice, here's one more thing to make life easy for you. Every fall I download every single plan's SOB, EOC, star rating, formulary and provider directory (where available) and keep them on my laptop's HD. That way I can pull any of them up in seconds and answer questions, check doctors, and the like. That way if you're in a place where the internet hasn't been invented yet, you still have a resource that could save you from making a return trip -- or losing a sale.

As to PDPs, a lot of agents don't fool with them due to the high maintenance and puny compensation. That is a huge mistake, IMVHO. Even if you drive 50 miles and end up with nothing but a SilverScript PDP enrollment, for example, if you treat them right, they may well give you referrals for more profitable sales (life insurance, annuities, MAPDs, etc.). I have gotten to the point where at least 25% of my business is referrals, and there's nothing better than "free leads," which is precisely what referrals are.

Everyone on here has his own business plan, but that is what works for me. Good luck.
Thanks Ronnie. All good stuff.
 
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