Medicare Needs Analysis Form?

[thomasm]

I'm now appointed and "Ready to Sell" for pretty much all the MAPD options in my local area. (except BSBC which isn't competitive here)

Besides just guiding clients through the Medicare.gov plan-finder tool and picking the one on top, is there a better way to narrow down the choices for someone new to Medicare?

Is there an official CMS compliant "needs analysis form" available?

Short of using a form, what are some the questions you ask at the beginning to determine which would be the most appropriate plan to discuss?

What questions do you ask to get an idea what their preferences might be regarding MG vs MA? (freedom of choice to choose providers vs. having an assigned primary care physician, etc.)

If going with MA, probably the first thing would be to ask who their chosen primary care physician will be, and then eliminate the plans not in the PCP's network.

Then probably the next thing would be to walk them through the Medicare.gov website, enter their drugs and then show the plan results. Do you just let them pick from there or do you go through each one starting with the one on top?

I know how to do a compliant MA/PDP presentation, I'm just curious what preliminary steps you guys take to decide which one to present?

Are there any online broker trainings available that go over how to do a "Medicare needs analysis"

What about a CMS compliant "competing plan comparison chart"? I usually show a client the SOB for all the plans, but having a side by side comparison sheet would be nice!

 

[cladams]

What plans do you have available? Are you in a rural area or metro - PPO/PFFS or primarily HMO?

For example, UHC/CIP's PPO - if the PCP is willing to bill the plan, then they will have the same copay as "In Network." So depending on the plan, the PCP may not have to be "In Network." For those PPOs, I call the Dr's office to see if they "accept patients with ____."


On the other hand, some folks have been thinking about changing their PCP, so for them to select another Dr to see is what they were considering anyway. Of course, most folks are happy with their PCP, and would never consider using another Dr, so for them the Dr will need to be in Network or willing to bill, depending on the type of plan.

 

[thomasm]

Mostly HMO's however Humana, and BCBS, have a PPO option. No PFFS here!

 

[cladams]

Here are my steps:

I start with medications, since a brand name Rx, and some of the expensive generics, if not in the formulary will be major deciding factors. No need to go through confirming Dr's and going over various benefits if their Crestor is not in the formulary.

If you have plans that will handle their Rx similarly, then confirm Dr's. If Dr's (PCP & Specialists) are NOT in network, or NOT willing to bill (If PPO), then you will rule out those options at this point.


Sometimes there is only 1 plan standing after these 2 steps. If more than 1 plan - compare benefits. I ask them how many times they went to the Dr last yr? If they went 2 times, then the difference between a $5 PCP copay and a $15 PCP copay is minimal, considering annual costs. If they go to their PCP, or specialist twice a month, then these copay amounts become a significant factor to which plan they may choose.


I then try to point to the "surgery caps" (ie $250 for OP Surg/Phys Svcs) and the MOOP, since these are areas where this plan may be able to save them significant $.

Then talk about the Extras. These will be just that at this point. They chose the plan based on significant benefits, then they find out they also get 2 dental cleanings per yr ect. Yes, some will ask about a "plan with dental"/"silversneakers" ect. I mention that some of the plans the I have, do have those benefits, but what if you had to switch Dr's to have the plan the offers a "SilverSneakers Membership?" Of course, most will say "no," then you will be able to start with - Rx, Dr's, # Dr visits, significant caps...


Hope that helps!

 

[somarco]

You are really making this too complicated. In no particular order, here is what I ask ........... then LISTEN and take very good notes.

Tell me what you understand about Medicare. Let's start with the 4 basic parts.

What does Part A cover?

Part B?

We will skip over C for now. Tell me what Part D does.

(At this point I know if they understand Medicare or not. If not, we do a remedial course in the 4 parts, including Medicare Advantage).

Once I know they at least have a grasp of Medicare I then ask .....

Do you have a regular doctor or doctors you would like to keep?

How often do you see a doctor during the year?

Do you take more than 3 medications? Are any of them generics?

(If they currently have a plan)

What do you like about your current plan?

What don't you like?

(If they are T65)

How long have you been looking?

Have you seen plans that you like? If so, why didn't you sign up?

What would you like to see that you have not already seen?

 

[HuntAssuranceGroup]

You are really making this too complicated. In no particular order, here is what I ask ........... then LISTEN and take very good notes. Tell me what you understand about Medicare. Let's start with the 4 basic parts. What does Part A cover? Part B? We will skip over C for now. Tell me what Part D does. (At this point I know if they understand Medicare or not. If not, we do a remedial course in the 4 parts, including Medicare Advantage). Once I know they at least have a grasp of Medicare I then ask ..... Do you have a regular doctor or doctors you would like to keep? How often do you see a doctor during the year? Do you take more than 3 medications? Are any of them generics? (If they currently have a plan) What do you like about your current plan? What don't you like? (If they are T65) How long have you been looking? Have you seen plans that you like? If so, why didn't you sign up? What would you like to see that you have not already seen?

Nice procedure!

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