Deliver a Successful Medicare Enrollment Season – What’s New for 2021

So, how can you, their trusted advisor, help them have a more successful AEP this year? Here are five solid tips:

1. The annual notice of change

Number one is the annual notice of change (ANOC). Every year, every Medicare Part D (prescription) plan and Medicare Advantage plan is required to send current plan members an ANOC. It details how their particular plan will be changing in 2021.

They should receive this document in the mail by late September.

All of the changes that the carrier will make will be in these documents. Is their pharmacy still a preferred one or did that change? Is their particular medication on the formulary or did that change? Does their physician still accept their medical plan, or did that change? Etc.

Common denominator word? “Change.” These documents are along the lines of what you provide to consumers in some of your transactions – think compliance documents. As you know, they are generally indecipherable to the consumer. They don’t want to dive into the details. They largely ignore the paperwork.

Here’s the downside. If your client had read the documents, they would have learned that their medication will no longer be covered by the plan long before they attempted to pick up a refill in February.

At that point, it’s too late to make a plan change.

Solution? Encourage your clients to look for the ANOC documents. They must be sure that they are okay with any changes before they sit back and allow the contract to renew for the new plan year. If they find that something has changed, they’ll want to look to make a plan change between October 15 and December 7.

Medications can be looked up online with Medicare’s Planfinder tool. This is a great tool that the consumer can use to see what their 2021 plan will look like as they input their specific medications and pharmacy selections.

2. Education

Education about Medicare sounds banal, but it is extremely important.

There are so many reasons that the Medicare consumer would love to make one selection regarding their coverage at age 65 and then put it onto the back burner for the next 30 years. But I guarantee that things won’t work out well if they take that approach. And, unfortunately, that doesn’t stop many consumers from taking that approach to their medical insurance.

Coach your clients in making the best of their annual season. They should be organized enough each year that their annual Medicare “check-up” is routine, just like their bi-annual dental appointments that they religiously set.

Here’s my agency’s solution to getting the client organized: they can access our 2020 Guidebook here. This guidebook was designed to educate the consumer and keep them organized. Some of your clients will love it; others won’t even open it.

There are links to our YouTube Channel within the guidebook. I find this a terrific way that clients can learn in the comfort of their own home and then yell when they need help. Your clients are struggling to find help with Medicare, but when they make a phone call to an agency or a call center, they are clobbered with “sales.” So they shut down and do nothing, which isn’t a good thing to do with Medicare. But it happens all the time.

Provide them with our resources and direct them to Medicare.gov. So much of the Medicare process is tied to understanding that the complicated system can be structured to best serve your client. Certain things need to be done at certain times. There are two general paths to Medicare coverage. A person should pick one or the other but, more importantly, understand what they picked and purchased, why they chose it and how it works. Then, find an agent who is there for you when you need them.

3. I chose wrong last year

The AEP can be for those who didn’t do such a great job learning and/or understanding their Medicare choices the first go around. So, bonus time – they may be able to approach this as a do-over season.

When a person is new to the Medicare system, I spend time showing them that they have two paths to choose from in terms of their medical coverage. One is Medicare Advantage and the other is Medigap.

These two plans differ in how they operate for the consumer. Annually, we meet people who had chosen a Medicare Advantage plan and during the course of the year found that there were more restrictions than they anticipated. They want to exit the plan and change to Medigap coverage starting 1/1/2021.

Can they do that? Maybe.

Bill was an engineer type who had spent six months calling carriers and researching plans. He settled on a Medicare Advantage plan. He then had shoulder surgery and another surgical procedure. He called us during the AEP in 2018 to get out of this plan. He said that it just didn’t pay out as he anticipated; it cost him much more than he thought possible.

At the time, Bill was still undergoing physical therapy related to his shoulder. He continued that for several months into 2019. This made him ineligible for Medigap insurance. He had to stay with the Medicare Advantage plan for another year. During the following AEP in 2019, Bill and his wife were both approved for Medigap insurance coverage beginning January 1, 2020.

His comments swirled around the fact that he thought he had researched the heck out of the plan types but realized he didn’t know the right questions to ask.

He was one of the lucky ones. Had he had a cancer diagnosis, there could be a period of years where he could not secure a Medigap contract - or he could never secure one. It happens more often than you might expect. People don’t realize that pre-existing conditions do appear during the Medicare years.

Do you have clients that have Medicare Advantage plans and are healthy and might want Medigap? The AEP is their time to start checking out options.

4. Big changes coming to Medicare in 2021

One in three Medicare beneficiaries has diabetes and 3.3 million beneficiaries use insulin. Access to insulin is very expensive for many. In 2021, CMS will introduce a Part D senior savings model to help with the costs of insulin. This will provide Medicare beneficiaries new choices for part D plans that offer insulin at an affordable and predictable cost where a thirty-day supply of a broad set of plan-formulary insulins costs no more than $35.

Read more here if you are interested. Here is a list of the affected insulins as well.

Another significant change to the Medicare landscape involves end-state renal disease (ESRD). Currently, those with ESRD are disqualified from enrolling into a plan. In 2021, that restriction will be lifted, and they may enroll into various plans. Read more here.

These two changes provide significant opportunities for consumers to save and receive better care.

5. Covid-19/Zoom/Virtual 2020

Bring some education in-house, virtually. Your clients are looking for the info; be the provider of good information for them.

Every grandparent has been on Zoom. Keep it going.

We are open to scheduling client sessions. The format is essentially a 30-minute overview of the system and time for your firm’s message and some Q&A. Contact us for more details.

Deliver a successful Medicare season

Your clients want help with Medicare. They want you to be the liaison to get good help. You want to be that great resource to your client so that they come back and thank you profusely for assisting.

It works. Deliver a successful Medicare season.

Joanne Giardini-Russell is a Medicare nerd with Giardini Medicare, which was created to help those approaching Medicare eligibility or those currently enrolled in Medicare better understand what they are purchasing and how their choices may affect their long-term outcomes regarding care, finances, etc.

Read more articles by Joanne Giardini-Russell