Medicare Advantage Rules Regarding Prescriptions

[Norwayguy]

Frank, What do you tell your clients to do to find a part D? I hate selling them for this reason to. I have moved to only med-supps and if I didnot have to do 1 more part D enrollment I would be happy.

Frank has said many times that he tells them to speak with their pharmacist...Which makes perfect sense these would be the people to know what drugs they are taking and also you don't run into the situation where once the client is locked into the plan the drugs they take change or the formulary change now they would be mad with the pharmacist not you....

I think the pharmacist can more easily deflect these types of issues ie by blaming it on CMS rules and the insurance company....As an agent I think the client equates us as the insurance company even though we have no control on these issues.

 

[Winter_123]

I think the pharmacist can more easily deflect these types of issues ie by blaming it on CMS rules and the insurance company....As an agent I think the client equates us as the insurance company even though we have no control on these issues.

Right, just this morning for example I enrolled a couple in med supps. I had talked with them on the phone and knew that they were also interested in Part D so I suggested that go down and talk with their pharmacist. Then I just went by and did the med supp enrollments.

I did this for a couple reasons. One, as you and Frank have stated, the pharmacist can give them an "independent knowledgeable view." But also, I dont want to frig with the Part D rules about getting written confirmation from them 48 hours in advance before I came by to discuss Part D. If they are good to go on the med supps, I want to be good to go.

Probably I violated some CMS rules. Maybe I upheld then digilently. Who the hell knows. I have not seen what today's rule changes are.

 

[Frank Stastny]

Frank, What do you tell your clients to do to find a part D? I hate selling them for this reason to. I have moved to only med-supps and if I did not have to do 1 more part D enrollment I would be happy.

As Norwayguy just said, I send them to the pharmacist. If the formulary they signed up under goes south, I do not want to "go south" with it.

It sure eliminates a lot of hassle and stress for me as well as keeping my credibility in tact. Since I can't certify with every company offering Part D plans it also insures that my client is getting the very best company at the time for the lowest premium available. (Damn that sounded good.)

 

[GreenSky]

Frank:

You know you're missing out on $25 commission. It adds up. I haven't totalled it up but I think I might have made $200 or so this year.

Rick

 

[Dave020]

Council on Aging is providing free Part D help right now as well.

 

[Frank Stastny]

Frank:

You know you're missing out on $25 commission. It adds up. I haven't totalled it up but I think I might have made $200 or so this year.

Rick

OMG, why didn't you tell me that I could make that kind of money selling Part D. Some friend you turned out to be.

 

[captain94]

When they talk to the pharmacist and they then call a company that the pharmacist recommends then the company tries to enroll them in a mapd and knock out your med supp? I ask because this has happened to me when the company sent out a captive agent to do the part D he knocked out my med-supp and enrolled her into a mapd and my client didnot undersatnd what happened when the med-supp would not pay any bills. has this happened to anyone else?

 

[Frank Stastny]

When they talk to the pharmacist and they then call a company that the pharmacist recommends then the company tries to enroll them in a mapd and knock out your med supp? I ask because this has happened to me when the company sent out a captive agent to do the part D he knocked out my med-supp and enrolled her into a mapd and my client didnot undersatnd what happened when the med-supp would not pay any bills. has this happened to anyone else?

Wow, that sucks. I have suggested to a lot of people that they go to their pharmacy. I have never had that happen and very honestly didn't even think about that happening. I do a pretty good job of selling the Med Supp and explaining the dangers in taking anything except a Medicare Supplement. I'll have to think about that one.

Okay, I thought "long and hard" about it. For a few seconds anyway.

This is what I came up with.

I only sell now in rural Missouri. When the PFFS plans go away rural Missourians will no longer have the option of taking a Part C plan.

The people I sell Med Supps to are already on Medicare and for the most part already have a Part D plan. If they ask me about Part D I ask them if they already have one and if they say yes I ask them if most of their meds are covered. If they again say yes I recommend that they keep it. (Switching plans just to save a couple of premium dollars may backfire on them in the cost they pay for their meds.)

I explain what a formulary is and that it can change without any notice. That is when I tell them if the plan they have now "ain't broke, then don't try to fix it".

I tell them that the cheapest Part D plan may end up costing them the most money.

 

[Cenla Agent]

There are ways you can ask without really asking, in other words, in a very indirect way, and usually get the information. But I don't know if even doing that would pass muster with CMS.

If you sell the member a plan that doesn't cover all of their medications and they complain later, whose fault is it going to be deemed to be? Especially when the companies typically only give out abbreviated formularies?
- - - - - - - - - - - - - - - - - -

When they talk to the pharmacist and they then call a company that the pharmacist recommends then the company tries to enroll them in a mapd and knock out your med supp? I ask because this has happened to me when the company sent out a captive agent to do the part D he knocked out my med-supp and enrolled her into a mapd and my client didnot undersatnd what happened when the med-supp would not pay any bills. has this happened to anyone else?

I can guarantee that the company will try to do this if they are a MA company in the state, unless the member flat out refuses an appointment and insists on enrolling over the phone.

If you want to go Frank's route, the best option (if possible) would be for them to go to their pharmacist to get his opinion and then enroll online.

If they don't mind long hold times, they can also call 1-800-Medicare with their list of meds, and I believe they can still enroll on the phone through them as well.

 

[Call4Insurance]

When they talk to the pharmacist and they then call a company that the pharmacist recommends then the company tries to enroll them in a mapd and knock out your med supp? I ask because this has happened to me when the company sent out a captive agent to do the part D he knocked out my med-supp and enrolled her into a mapd and my client didnot undersatnd what happened when the med-supp would not pay any bills. has this happened to anyone else?

You are doing an injustice sending your customer to the pharmacist. I worked pharmacy for many many years and the first company to get hold of the pharmacy and get them to come on board with their card, give them a kickback for each application enrolled is who they point them to.
I did drug cards in the pharmacy long before I got licensed and I was told to sell the ccrx card, signed over 200 customers and the pharmacist got a nice check and I got jack sh**.
I sit with the customer, get this list of drugs, do some research (which is our job if you care about your customers) and find them the best drug card available.
I have made many happy repeat customers just taking the time to help them, my annuity business is doing well because they now trust me with the small stuff.