[Guest Blog] An Agent’s Perspective: The Benefits of Selling Prescription Drug Coverage This Enrollment Season

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Let me tell you a very short story. 

When I became an agent in the Medicare world, I understood there were four parts of Medicare. We are all familiar with Part A (hospital) and Part B (physician). Then come two much more complicated parts: Part C (Medicare Advantage) and Part D (prescription drug coverage or PDP). 

I understood my role as an agent was to help educate and support my clients on their Medicare journey. However, early into my first Annual Election Period (AEP), I started having clients come to my office for assistance with Part D coverage. I was confused as to why a client would only seek out the assistance of an agent for just drug coverage. So, I always asked how they enrolled in their Medicare Supplement, Medicare Advantage, or MSA plan. I would get the same answers over and over:

• "My agent said they are not licensed to work with drug plans, just Medicare Advantage.”
• “My Agent told me they don’t have the software/program.” 

At first, I would brush it off and help with the drug plan. However, after a bit, I started telling my clients that their agents misled them. I would show them how the information was on Medicare.gov to look up Medicare Drug plans. These clients would quickly end up converting to a product I sold so they could become my clients. 

Fast forward 10 years, and I have gotten hundreds of clients due to agents skipping PDP offerings. This, in turn, brought countless referrals — and we all know that brings in more commissions.

Medicare Part D plans started on January 1, 2006. Since then, they have only become more confusing to Medicare members. Plans cover different medications, member cost share, deductibles, and pharmacies. Those moving parts alone would be confusing enough to people but then add in the coverage gap (donut hole) and catastrophic phases. 

I would get many calls asking why the cost share a client was paying changed, only to have to remind them of the donut hole. Often, I had to explain to a client that there is no out-of-pocket max (OOPM) and they would pay thousands of dollars every year for their needed medications.

This upcoming Annual Election Period is on track to be the biggest year for Medicare Part D, outside of 2006 when it started. 

In 2022, the Inflation Reduction Act (IRA) was passed. This brought many changes for climate, energy, tax, deficit reduction, and, most important to us, healthcare. In short, the Medicare Prescription Drug Pricing Reform:

• Enabled Medicare to negotiate prices for certain high-cost prescriptions
• Ensured that vaccines covered under Part D are available and free to beneficiaries (including, but not limited to, the shingles vaccine and TDAP)
• Placed a $35 monthly cap on insulin (if your plan covers it)
• Eliminated the coverage gap (donut hole)
• Placed a $2,000 annual out-of-pocket max for covered prescriptions

Let us not forget about the easy-to-understand (yes, sarcasm!) Medicare Prescription Payment Plan (M3P). The M3P will allow a Medicare member covered by a Part D plan to “smooth” out early-year medication fills via a payment plan. This means that the Medicare member will not pay anything when picking up these medications, but the Part D plan would. They would then “smooth” the large payment into smaller, more manageable monthly payments throughout the rest of that plan year.

These are some major changes that are going to change the landscape of Part D coverage — including in Medicare Advantage Prescription Drug plans. This brings an even greater need for Medicare members to seek out agents to help with navigating these changes. 

These changes will affect anyone enrolled in Medicare, even if they are only enrolled in Medicare Part A and delayed Part B because they were/are still working and have employer coverage. Keep in mind that Medicare members who delayed Part B and stayed enrolled in their employer coverage did so with the understanding that the coverage from the employer met Medicare’s minimum standards for creditable coverage, thus protecting them from any late enrollment penalties (LEPs). 

However, unless CMS grants a waiver for those already on employer plans, those beneficiaries will lose creditable Part D coverage starting January 1, 2025. This is because most, if not all, employer plans include prescription coverage under the plan’s overall deductible and out-of-pocket max. 

Since all Medicare drug plans now must place an out-of-pocket max of $2,000, this would make the prescription coverage offered by the employer not as good as Medicare’s and that it's no longer "creditable coverage." This means the thousands of people who are still working and using employer coverage will now have to seek out assistance with finding creditable prescription coverage per Medicare’s guidelines.

The days of agents grabbing the easy fruit (Medicare Advantage and Medicare Supplement) and leaving the hard-to-reach fruit are gone. Clients are expecting more out of their agents — as they should! 

We are educated and tested experts in our field. Pair that with outstanding CRMs like AgencyBloc’s AMS+ solution and enrollment platforms like Medicare Edge or Lead Advantage Pro, and there is no reason for agents not to offer all the products to their clients.

When I first started doing Medicare Part D drug plans, there was only Medicare.gov to use. That worked ok until they took away the ability to save drug lists without an account. I then had to save a record of all my clients’ medications each year and manually put them all into Medicare.gov’s pricing tool. Then, I would have to go out to each individual carrier’s enrollment platform to complete enrollments. There were so many passwords and websites to remember — not to mention all the applications we would have to save and file. 

Now, with AMS+, I can gather and save each medication list every year in one easy-to-follow Activity. Once we paired AMS+ with Medicare Edge and Lead Advantage Pro, it was like a dream. With the click of a button, all my client’s information was sent to Medicare Edge or Lead Advantage Pro via the integration with AMS+. I can easily save medication lists and pharmacies in Medicare Edge/Lead Advantage Pro. Plus, I can put side-by-side plan comparisons for my clients to easily see and understand. 

Once a plan has been selected, you can even complete the enrollment in Medicare Edge or Lead Advantage Pro, and the application and enrollment history is stored. Fantastic!

These changes from CMS are going to make an already busy Annual Election Period even more fun (yes, sarcasm again). Some things we can expect:

• Premiums will be changing — some getting higher and some actually lower
• Formularies will get tighter
• Prior authorizations will increase

Plus, some companies have decided to exit the Part D market altogether. In short, Medicare members will be more confused than ever and need our help. 

If helping someone is not enough of a reason to work with the Part D market, the extra revenue should be! I know we are all salespeople, but we are also educators and advocates for our clients. I have never lost a client who has come to me for help with Part D coverage only. In fact, they have ended up purchasing dental coverage, vision coverage, indemnity plans, and life insurance policies. These all add up to more commission for me! 

Yes, I realize that some carriers are going to stop paying commissions on Part D plans. However, keep in mind that we are trained professionals that are here to help people. When you help someone, they can’t help but tell others what you have done for them, and this will bring more leads and more commissions.

To me, there are only upsides to working with and selling Part D policies.

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Posted by Josh Sterling on Wednesday, September 4, 2024 in Senior Market Insurance

1. client retention
2. marketing
3. open enrollment
4. prospecting
5. selling