Part C

[MAPDagent]

Actually, I've been told by more than one carrier that you can and should inquire about a prospect's medications in order to help them understand exactly what their costs will be. That's part of what our job is in marketing drug plans.

On the other hand, you are not allowed to ask health questions because it could be construed as 'health screening'...I know, sounds kind of silly, but rules are rules. Now, if you know what medications the client is taking, and you've been in this line of business for any length of time, you should be able to quickly ascertain what their health situation is without ever actually asking a health question.

 

[scottfree]

Scottfree:

How do you contract with BC/BS to sell Med Sups? Here in Kansas and Missouri, BCBS has no agents. They only sell directly to beneficiaries and that's why they say they offer the lowest cost plans. Indeed, their plans are the lowest across the board. I can sell BCBS individual health plans, but not Medicare plans. I assumed this was the same for other states as well.

Anyone else out there have info about BCBS Med Sups, please chime in.

retread, I called up the BCBS office and they have training seminars a couple times a year. I just got back yesterday from one in Little Rock. They have a person in charge of independents and then someone in charge of farmers or state farm agents. They need independent agent as far as I can tell, I have more MA clients than BCBS has, they had only 450 total for last two years.

This is in Arkansas so not sure how it works in other states. I know they stree online enrollments so I have to have an aircard to do apps online in clients home. They will take faxed apps but they really only want online.

Can't hurt to call the office in your state, never know what they will say.

 

[dandan]

MAPD Agent

It is Completely against CMS regulations to ASK for meds, if you come out and ask you will eventually get caught. You know they will have secret shoppers out, someone earlier stated they are going to make examples of agents this season.

As a Part C agent, CMS states it is not our job to Sell but to inform about the plan we offer and let the client make the decision to buy.

This is why I am very concerned about these plans, as an Insurance agent I'm feeling like a pawn.

 

[insurance0707]

You would think that you could ask them about their medications. The Blue Cross MAPD plans in my state have 4 different plans. 2 that cover generics through the gap and 2 that don't. You can enter the medications into Medicare or the Blue Cross website and it shows which plan would do the best job for the client, based on their medications. How can CMS think that is a bad thing? They should reconsider that rule. Even pharmacists will run people's medications and give them a printout. Does CMS tell the phamacist that you can't ask about the clients prescriptions.....

 

[dandan]

I agree with you I think you should be able to ask. The pharmacist can, a senior advocate can, actually anybody can...except a commissioned agent. ????????????

 

[retread]

As I understand the concept of "cherry picking", it is denying enrollment of someone who will obviously file a multitude of claims due to poor health. That is why you can't ask HEALTH questions. However, how else can you properly enroll someone in the proper drug plan if you don't ask them what medications they are on?

I sell SNPs with multiple formularies. You absolutely cannot enroll someone in the proper plan (and associated premium) without determining which formulary to use, which requires that you know their medications.

Also, you are derelict in your duties if you sign up someone in a MA-PD, whether it is SNP or any other MA-PD, if you do not determine if they will be covered with their medications in that plan. You always must refer to the plan formulary, just as you should enquire if their doctor is in network, etc.

Where in the world did you get the idea that you cannot ask a prospect about their meds?

 

[Cenla Agent]

As I understand the concept of "cherry picking", it is denying enrollment of someone who will obviously file a multitude of claims due to poor health. That is why you can't ask HEALTH questions. However, how else can you properly enroll someone in the proper drug plan if you don't ask them what medications they are on?

I sell SNPs with multiple formularies. You absolutely cannot enroll someone in the proper plan (and associated premium) without determining which formulary to use, which requires that you know their medications.

Also, you are derelict in your duties if you sign up someone in a MA-PD, whether it is SNP or any other MA-PD, if you do not determine if they will be covered with their medications in that plan. You always must refer to the plan formulary, just as you should enquire if their doctor is in network, etc.

Where in the world did you get the idea that you cannot ask a prospect about their meds?

Because that's the rule. Claims are claims, whether it is meds or other medical costs.

I haven't sold SNP plans, so I don't know if there's any difference there.

In the past couple of years I've only sold Humana, which has the same formulary for all plans, whether PDP or MAPD. When you start talking about differences in Rx coverage, usually they will give you the info on their meds. Quite often, especially during 2005-2006 when Part D rolled out people would come to me with a list of their meds or with all of them or start pulling them out if they were at home. I honestly can't think of a case where I was in a position where I thought I needed to ask for that information, and I never have asked for it.

 

[dandan]

Well, it was drilled into all that attended a Humana delegated agent training. You may ask leading questions to get them to offer meds but you can't ask them to tell you the meds they take.

I thought I would offer advantage plans, but I think I'm going to stick with med supps. The only time I plan on offering advantage is if it is a under 65 disability.

I met an agent the other day that committed a section A violation last year. I think he is in his early 60's, he had a call from a med supp client that wanted him to come out and enroll his wife in a supp plan, she just turned 65. After the sale he asked if they knew of anybody interested in his plan, they said to go see his brother inlaw down the road.

The man went to the brother inlaws home and was invited in, he found that the man had a advantage plan and his wife would be getting medicare 4-5 months later, the agent also offered the advantage plan that the husband had and told them when she is ready he would be glad to help her.

A few days later the wife had a question and called this agent, she left a message on his voicemail he was not in. She also called the advantage company and said to please have this agent that dropped by her house to call her.

They asked why the agent dropped by and she told them he was going to get her on the same plan as her husband. The company called and questioned why he went to the house without an appointment, he explained and told that he was going on a med supp referral. He was told when he mentioned the advantage plan the whole call changed. They terminated his contract and it is still being investigated by CMS.

 

[scottfree]

I agree with you I think you should be able to ask. The pharmacist can, a senior advocate can, actually anybody can...except a commissioned agent. ????????????

You can't ask "What are the Medications you are taking" but there are acceptable ways to have them tell you what they are and not be violating any rules. I have yet to have 1 person not tell me what drugs they have, including Viagra and other possibly embarrassing drugs. It is a stupid rule but easy to get around since 95% of the people do really want help. Most have their list and just hand it to you.

But you can say..

Medicare doesn't allow me to ask what meds you are on but you are allowed to tell them to me if you wish, otherwise you can go the Medicare website to check for yourself.

 

[scottfree]

Well, it was drilled into all that attended a Humana delegated agent training. You may ask leading questions to get them to offer meds but you can't ask them to tell you the meds they take.

I thought I would offer advantage plans, but I think I'm going to stick with med supps. The only time I plan on offering advantage is if it is a under 65 disability.

I met an agent the other day that committed a section A violation last year. I think he is in his early 60's, he had a call from a med supp client that wanted him to come out and enroll his wife in a supp plan, she just turned 65. After the sale he asked if they knew of anybody interested in his plan, they said to go see his brother inlaw down the road.

The man went to the brother inlaws home and was invited in, he found that the man had a advantage plan and his wife would be getting medicare 4-5 months later, the agent also offered the advantage plan that the husband had and told them when she is ready he would be glad to help her.

A few days later the wife had a question and called this agent, she left a message on his voicemail he was not in. She also called the advantage company and said to please have this agent that dropped by her house to call her.

They asked why the agent dropped by and she told them he was going to get her on the same plan as her husband. The company called and questioned why he went to the house without an appointment, he explained and told that he was going on a med supp referral. He was told when he mentioned the advantage plan the whole call changed. They terminated his contract and it is still being investigated by CMS.

dandan,

I think just offering Med sups is not the right thing to do either. If you follow the rules which are clear cut you will not have any problems. I know that what that man did was a violation, he could have avoided it easily. I have had that situation come up several times with the friend next door or down the street knowing that I had an appointment with their friend and they wanted to have me contact them when I was done. All I said was that CMC does not allow me to do this but if you call your friend up and see if he wants to talk to me, have him give you the phone and then set the appointment. I actually have a little fun with it and say lots of different things but bottom line is it is totaly legal to do this.

Another thing is get to know the client a bit ask them what they want and are looking for and let them know you have several options. See what they have already and what they have looked or heard about. Med sups are good but MA's can also be a great fit. Senior don't hold anything back for the most part and are really enjoyable to work with most of the time. If they are confrontational, I usually say something and get the heck out of there, doesn't happen much but it does happen.

Bottom line is if you don't try to make a sale and do what you believe is right for the person, you will be just fine. Follow the rules and if you are not sure about something don't do it. Good luck.