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10 Ways to Avoid Rapid Dis-Enrollment

10 Ways to Avoid Rapid Dis-Enrollment | Senior Market Advisors

During the Annual Enrollment Period (AEP), clients have the option to make changes to their health care. If you’re not careful, your clients may buy from someone else or make an uninformed decision to disenroll.

There are many different reasons a person would choose to disenroll. For example, many people simply misunderstand what their plan covers. Others may find out they qualify for a different plan, then choose to enroll in that one. Some people forget what you discussed and start to doubt their new plan.

Preventing disenrollment is much easier than selling to a completely new lead. Happy customers tend to be repeat customers, which will increase your overall business. Plus, satisfied customers are more likely to promote your company, which will then lead to more new customers. Use these 10 tips to help ensure client retention and satisfaction.

Agent Avoiding Rapid Disenrollment - Senior Market Advisors

1. Always be prepared. 

Have all sales materials easily accessible, ask appropriate warm-up questions, and lay the foundation for referrals. You want to position yourself as an authority in Medicare, and appearing organized is a great way to do that.

2. Learn what your client needs.

Conduct a thorough Needs Analysis to help the prospect sign up for the most appropriate plan based on his/her needs. Your needs analysis should include items such as:

  • A prescription drug list including dosage and quantities
  • The client’s PCP and if they’d be open to finding a new provider
  • If the client sees any specialists, how often, and if they’d be willing to look into plans that don’t include those specialists
  • The client’s preferred hospitals and pharmacies

Also, talk to your prospects about where they live. Ask if they live in another state part-time and for how many months of the year. These questions will help you determine what plans to present.

3. Leave the right information.

Present the Enrollment Kit in its entirety and leave it with the customer. You want your customer to be able to review everything their new plan has to offer.

4. Do not leave anything out.

Ensure the prospect understands and agrees with the plan’s effective date, premium, and benefits. Also explain the plan’s deductible, out-of-pocket maximums, and any copays or coinsurance your customer will owe.

5. Have your customer select a primary care provider.

Encourage the prospect to select a PCP instead of having one auto-assigned. You want the client to be happy with their PCP, and that includes proximity to their home, what services the PCP provides, and the client’s relationship with their PCP.

Many things can contribute to rapid disenrollment, and dissatisfaction with a PCP may be one of them. Your client may not know that they can look for a different doctor.

6. Help your clients access their provider networks.

Ensure the customer understands how to access a provider and explain any network & provider limitations (including referral requirements when applicable).

Your prospect is much less likely to drop their coverage if they understand how to find the providers they need. For example, many HMOs require a PCP referral when a beneficiary needs to see a specialist. Explain how your client can gain access to specialist services and make sure they’re comfortable with the requirements.

7. Do not use a P.O. Box for your client’s primary address.

Provide the client’s physical address in the residential address portion of the enrollment form. You must look for plans in the zip code where your client actually lives according to what the Social Security Administration has on file. Your client’s application will automatically be denied if the addresses don’t match.

Note: your client can list a P.O. Box for a mailing address to receive CMS mailings.

8. Educate your client about authorized representatives.

Explain that an Authorized Representative must provide documentation to the health plan and/or CMS if requested. For Medicare, that means the client or a representative who has durable power of attorney is the only person who can enroll in or make changes to coverage.

Your client’s application will be denied unless the right person signs it.

Subscribe to our podcast and listen to Episode 11: “Understanding Power of Attorney for more information on authorized representatives.

Selling SMART Podcast

9. Explain how to cancel an enrollment application.

Review the enrollment application cancelation process with the customer. Explain that your client has seven days from CMS’ verification letter to cancel the enrollment request.

Your clients should also know when they can make changes to their coverage if they need to including what enrollment periods they qualify for.

Explaining how to cancel an application can actually encourage your customers to stick around. Instead of just dropping their coverage, your clients will come to you with questions about what they qualify for and when.

10. Review the Outbound Education and OEV process.

Go over the Outbound Education and Verification (OEV call or letter) process with the customer. Otherwise, your client’s application could be denied. An outbound call is one you make to the enrollee, and you can’t be on an outbound call when you actually enroll. Your client must call you, which is an inbound call.

Common Mistakes Agents Make

Insurance Agent Learning About Mistakes - Medicare Plan Finder

It can be easy to do the wrong thing sometimes. In the insurance agent world, that means losing customers. Avoid these common insurance agent mistakes including:

  • Not conducting a thorough Needs Analysis with the enrollee: For example, your client may really like their primary care provider. You may help them enroll in a plan that has every benefit they want, but their PCP doesn’t accept it. That’s a surefire path to rapid disenrollment. Your competitor may swoop in and find a plan that covers the same benefits including the PCP.
  • Using only the printed directory to verify the provider at the point of sale: Provider networks can change often, and you want the most up-to-date information. Be sure to verify that your customer’s doctor is in the plan’s network. Even online directories may be outdated. The best option is to call the provider’s practice and verify that they accept your client’s plan.
  • Having no knowledge of all drugs in the plan: We’re not saying you need to be a pharmacist, but you should go over your customer’s prescriptions including specifics such as dosage, how the drug is administered, and if the client needs a brand-name drug. Talk about what your customer will pay. This allows your client to make an informed decision and it can help eliminate surprises with prescription costs.
  • Not reviewing all plan benefits and limitations as listed in summary of benefits: For example, some plans have fitness benefits. Each policy may have different benefits and not every gym partners with every insurance carrier. Your client may show up at their gym one day expecting to get started, but the fitness center turns them away. That could be avoided by discussing all of the plan’s benefits and answering all of your customer’s questions.
  • Not providing contact information: If your clients can’t contact you, you won’t be accessible for answering follow-up questions. After a meeting, leave your customers with some business cards. This not only gives you an opportunity to get referrals while staying compliant but it also opens the door for two-way communication.

Not following up with clients is another way to lose enrollments. Your clients may not be happy with their plans. Call your clients periodically to gauge their plan satisfaction.

If they aren’t happy, explain their options for new coverage. For example, you may call a Medicare Advantage beneficiary during OEP, and your customer may say, “I don’t like this plan because the deductible is high.”

As long as your customer agrees to meet and fills out a Scope of Appointment form, you can go over different Medicare Advantage plans in the area, or explain what the customer would pay with Original Medicare only. You can also talk about Medicare Supplements, provided that they’re on the SoA.

Your goal is to help your prospect find the coverage they need. Customer retention is key because many carriers pay commissions for re-enrollments.

Let Us Help With Customer Retention

At Senior Market Advisors, we understand what agents need. How? An agent founded our field marketing organization. For example, we offer extensive sales training so you can go into your meetings fully prepared.

You can also gain certification to sell plans from all of the major carriers. That makes disenrollment less likely because you’ll have more options to present.

Our marketing team can help make a huge difference in your retention rates. If you’re interested in getting help at little cost to you, give one of our agent advisors a call at 1-844-452-5020 or eContract with us now!

This post was originally published on April 18, 2016, by Anastasia Iliou. The latest update was on January 7, 2020, by Troy Frink.

Anastasia Iliou
Anastasia Iliou
Senior Content Manager at Senior Market Advisors
Anastasia graduated from Belmont University with a Bachelor's degree in Songwriting. When she's not writing, she's on a mission to visit all 50 states in the U.S (and to date has reached 43). Anastasia loves writing music, hiking, and playing with her pets (hedgehog, dog, and two cats). She loves animals (but not so much bugs) and spends her free time volunteering for The Elephant Sanctuary in Tennesee.