I'm Starting to See the Light... Part D Hassle

G.Gordon

Guru
1000 Post Club
3,182
Missouri
Others, including Frank, have said they don't mess with Part D stand alone plans due to client frustration, wasted time, and all the other BS that goes with it.

I'm starting to see the light. After having to explain the same concept to the same client over and over and over, after feeling like they are blaming me for short comings in the Part D program... even though I fully explain it, I'm about ready to do as others have done and stop offering assistance with the program at all. We don't get compensated for the time it takes to even reflect 1/10th of the hassle, liability, and risk we endure to "help".

What causes me to feel this way:

In Missouri we have a program called Missouri Rx. If you make under the income limits for the plan they pay 50% of an enrollees drug cost all year. Half of everything, deductibles, co-pays, and in the dough-nut hole. Not a bad program for free. Every year I've had the state send me 250-300 MORx applications since I run into so many folks that qualify, but have never heard of it. Just being a helping agent that cares.

Madge calls last week. She's upset that she's in the gap. I explain that nothing can be done, but bring up that she should be paying only half since we visited the subject of MORx last season (per notes in the cover of her file). "I don't have MORx", she says. Why not... blah blah blah.

Long story short... I know... tooo late.

She's blaming me that she was not enrolled in MORx and hinted to my wife that she should be "compensated" for the $530ish that she would have saved if enrolled.

Here's the kink. I don't enroll folks. I explain the program and maybe fill out the application if they are current clients, but if not I just leave the application. When they mail the app to the state they have to have copies of the medicare and social security cards so this is why I'm usually not the one "mailing" the app.

I'm seriously close to leaving the whole Part D section of senior insurance alone like Bill leaves Hillary alone.
 
Welcome to the club. Just hope she doesn't call the DOI and file a complaint against you.

No one busts their butt for their clients more than I do, maybe as much but not more. My exposure and liability is too great to make me want to help people like that.

I send them to their local drug store. Let the guy who is making the big bucks help them. That's too big a monkey to have on my back.

It has nothing to do with the amount of commission I make or don't make. It's about my credibility.
 
I doubt she'll file a complaint. She's not that type. I "helped" her apply again and this time made sure it got mailed. We'll see what the outcome is. I'm suspecting that either I mentioned the income limits and she said, out of pride, that she was over the limit so I dropped the subject, or I left the application filled out for her to get copies of the cards and mail herself and she failed to do so. Either way... I mentioned the program and educated a client on a possible free benefit that if not for my efforts would have remained an "unkown".

I'm waiting on the determination from the state (Lisa is checking daily) and if she gets turned down then I'm golden, if not I'll diplomatically handle it with the only two possible situations that could have been fact last year.

Credibility... that's my biggest concern. Every time I get a sitational call like this from a client I have to wonder who and how many they've complained to. I've actually learned of clients "troubles" via other clients that have told me to call the troubled client. So... they do talk.

It's too late to back out this season. I may reduce my exposure to assisting existing clients that "come in" for help.

For clients that I can't get into the office I will use the plan finder on Medicare.gov to suggest plans, mail the findings to the client, and suggest they call the company to enroll.

ALL NOTED IN THEIR FILES.
 
This is not meant to be a "plug" for YIO but the Comment box automatically date/time stamps every entry I make. I log all conversations with clients and prospects. More than once that has saved my butt with I get questioned about something. I have documentation down to the second that I entered it.

This has become a big time CYA business. A senior can say or make up anything, even if it isn't true, and the DOI is going to automatically assume that the agent is at fault.
 
I have assisted well over 500 of my senior clients w/Part D's. I have been a health ins broker for 30 years. NOTHING has ever caused me as much grief as Part D. I don't care how many tines you tell a senior, "with your existing prescriptions, you will probably reach the coverage gap before the end of the year", they will not remember! This is the time of the year I receive this type of daily telephone call," I went to the pharmacy today and my prescriptions were $387. Last month they were on $75". Changes to the formulary, prior authorization, step therapy. These are all terms you will come to know quite well.
 
Well she sure as hell blames me.

"$540 Gordon... shame on you."

I'm not worried about a DOI complaint since this is a non-insurance matter and would fall outside the DOI authority. She's sure got her dander up though.
 
OK

What am I missing?

When I get a referral (which is how 100% of my Medicare business is generated), I get a list of docs and meds. Then I see what meds are not available at Kroger for $4, and are on the list. Then I tell the MB that no plan is perfect, and the best I can do is $x.

I tell them to keep going to Kroger, Costco, etc. and only use the PDP when there is no other option. I use Humana's tool to show them when they should expect to hit the gap, and how much it will cost (if they are in that situation).

Haven't had a complaint in three years of selling PDP's.

Knowledge. Give them that, and they feel empowered, and know what to expect.

I think Frank is right. If you feel it's too much of a liability, don't get involved. That's why I don't sell Dental or Vision EVER.

I also don't sell:

AFLAC
Variable Annuities
UL

Go with what you know.
 
In a perfect world, things go smoothly. In reality, clients at this stage of life are beginning to slow down mentally and don't always remember what you told them. And formularies do change, and prescriptions change....so where does that leave the agent? What control do you have after the sale?

Personally, I don't seek the Part D client. I want the whole turkey, not the bones.
 
I fully understand about the "knowledge is power" line of thoought. The issue is just what you said.. at this point in their lives they don't remember 11 months down the road that you really did leave them the MORx application, tell them when they'd enter the gap, or to get their $4 drugs outside the plan.

I could care less to ever be involved with the Part D issue, but helping them make the right decision could save them $$$$hundreds$$$$ in their lives. Give me a med supp that stays on the books, pays me a monthly income, and I'm a happy camper.

I'm brain storming on ways to announce my limited support for part D this year. I do a monthly newsletter and have already called attention to MORx changes, the fact that the AEP is coming, etc.

Now... how would I word it in the next newsletter that due to liability, complaints, limited compensation, etc. I'm am unwilling to do it any further???
- - - - - - - - - - - - - - - - - -
How's this:

Medicare Part D:

Due to several factors spelled out below my office will conduct limited assistance with Medicare Part D plan changes this AEP or Annual Election Period.

Liability: Due to the ever complex nature of Medicare regulations our very carriers as insurance agents could very well hang in the balance of the complaint from ONE person that is not pleased with our service in relation to the drug plans. No matter how carefully we assist each of you in selecting a drug plan the fact remains that the plans change after the selections have been made. The Medicare drug plans have limited benefits and year after year we get calls from members angry that they are in the doughnut hole or coverage gap even though we clearly explained the limits of the plan.

Credibility:
When a client is displeased with something that we've been involved in we lose credibility. Someone that is not happy tells ten people... someone that is happy tells one. So, no matter how much we help, if someone gets mad due to circumstances beyond our control WE lose... every time.

Compensation:
On average we are paid $20-25 per YEAR for assiting a medicare beneficiary with Part D decisions. Think about this when you consider that for the plans we chose to carry this year Lisa and I have spent two full work weeks doing the certifications required by medicare to have the "right" or "ability" to assist clients in making decisions in regards to the drug plans. And even tough we took the time to cert. for these plans if our research for a particular beneficiary indicated that a plan that we did not represent was best for them we helped them enroll in that plan... FREE of charge.

Bottom Line:
Last season I spent the better part of 1.5-2 months doing nothing but helping clients with Part D. For all those long days, long distance phone calls, etc. I maybe made a few hundred dollars. For the rest of this year I have had to defend my suggestions and actions. Several times I have been made out to be the bad guy for trying to help. In addition, for my Missouri clients, I allways ask about a clients participation in Missouri Rx. If they don't have it I explain the plan and if eligible I leave an application. I don't get compensated for this. We ask the state for 250-300 applications per year to HELP clients save money. GUESS WHAT!!! Now I even have one client that blames me that she wasn't enrolled in MORx last year. Where's the justice? I give.

NOTICE!
We will be very limited in our assitance for drug plans this AEP. We suggest that each beneficiary use other resources such as family, community senior centers, or your pharmacy to assist you in making drup plan choices for the next year. These people are not licensed insurance agents and are not held to the same medicare regulations, state regulations, and possible libility standards as I am.

I love what I do for you folks. And from the referrals, comments of gratitude, and other signs, I assume that most of you are appreciative of our efforts. My ability to do a good job for you could well be in risk due to the actions of ONE person that decides that I did not do something right in relation to a drug plan. My carrier is not worth it. For any inconvenience this cause I am truely sorry to the depth of my heart. This decision is not made lightly. Other agents have made the same decision due to what could be at stake.

Thanks.
 
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I fully understand about the "knowledge is power" line of thoought. The issue is just what you said.. at this point in their lives they don't remember 11 months down the road that you really did leave them the MORx application, tell them when they'd enter the gap, or to get their $4 drugs outside the plan.

I could care less to ever be involved with the Part D issue, but helping them make the right decision could save them $$$$$$$ in their lives. Give me a med supp that stays on the books, pays me a monthly income, and I'm a happy camper.

I'm brain storming on ways to announce my limited support for part D this year. I do a monthly newsletter and have already called attention to MORx changes, the fact that the AEP is coming, etc.

Now... how would I word it in the next newsletter that due to liability, complaints, limited compensation, etc. I'm am unwilling to do it any further???
- - - - - - - - - - - - - - - - - -
How's this:

Medicare Part D:

Due to several factors spelled out below my office will conduct limited assistance with Medicare Part D plan changes this AEP or Annual Election Period.

Liability: Due to the ever complex nature of Medicare regulations our very carriers as insurance agents could very well hang in the balance of the complaint from ONE person that is not pleased with our service in relation to the drug plans. No matter how carefully we assist each of you in selecting a drug plan the fact remains that the plans change after the selections have been made. The Medicare drug plans have limited benefits and year after year we get calls from members angry that they are in the doughnut hole or coverage gap even though we clearly explained the limits of the plan.

Credibility:
When a client is displeased with something that we've been involved in we lose credibility. Someone that is not happy tells ten people... someone that is happy tells one. So, no matter how much we help, if someone gets mad due to circumstances beyond our control WE lose... every time.

Compensation:
On average we are paid $20-25 per YEAR for assiting a medicare beneficiary with Part D decisions. Think about this when you consider that for the plans we chose to carry this year Lisa and I have spent two full work weeks doing the certifications required by medicare to have the "right" or "ability" to assist clients in making decisions in regards to the drug plans. And even tough we took the time to cert. for these plans if our research for a particular beneficiary indicated that a plan that we did not represent was best for them we helped them enroll in that plan... FREE of charge.

Bottom Line:
Last season I spent the better part of 1.5-2 months doing nothing but helping clients with Part D. For all those long days, long distance phone calls, etc. I maybe made a few hundred dollars. For the rest of this year I have had to defend my suggestions and actions. Several times I have been made out to be the bad guy for trying to help. In addition, for my Missouri clients, I allways ask about a clients participation in Missouri Rx. If they don't have it I explain the plan and if eligible I leave an application. I don't get compensated for this. We ask the state for 250-300 applications per year to HELP clients save money. GUESS WHAT!!! Now I even have one client that blames me that she wasn't enrolled in MORx last year. Where's the justice? I give.

NOTICE!
We will be very limited in our assitance for drug plans this AEP. We suggest that each beneficiary use other resources such as family, community senior centers, or your pharmacy to assist you in making drup plan choices for the next year. These people are not licensed insurance agents and are not held to the same medicare regulations, state regulations, and possible libility standards as I am.

I love what I do for you folks. And from the referrals, comments of gratitude, and other signs, I assume that most of you are appreciative of our efforts. My ability to do a good job for you could well be in risk due to the actions of ONE person that decides that I did not do something right in relation to a drug plan. My carrier is not worth it. For any inconvenience this cause I am truely sorry to the depth of my heart. This decision is not made lightly. Other agents have made the same decision due to what could be at stake.

Thanks.

That is very well done and thought out. It sounds like an attorney labored over it to make sure every contingency is totally covered. A beautiful CYA statement.

With that said, I don't think anyone will either read or understand it. It is way too long and reads like the language in the policy they get. I think you are trying to over think it and make it much more complicated than it needs to be. You are giving them way more information than they need.

I simply tell them that there are so many companies offering the PDP coverage that there is no way I can certify with all of them or become an expert on meds and know which one is the best for them. That my area of expertise is Medicare Supplement insurance not prescription medicine.

You wouldn't go to your pharmacist for help selecting a Medicare Supplement policy nor should you look to your insurance agent to be an expert about prescription medicine and the plan that offers you the best coverage. Ask a real professional, ask your pharmacist for help.

I'm sure you can greatly improve on that. I was just typing thoughts.

Every prospect/client I have said that to completely agrees with that train of thought. That is logical, they can understand it and they agree with me.

I tell them, and it is true, that I just don't feel comfortable or qualified to help them make that decision. I recommend they take a list of their meds to the drug store and get help from a real professional.

I've said this before and several said that I am going to lose my client to the next agent who knocks on their door if I don't sell them a PDP. That's not going to happen.
 
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