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Ultimate Guide to Selling Medicare Advantage Plans

By  Senior Market Advisors  on October 16, 2019

AARP predicts that 79 million people will enroll in Medicare by 2030. According to the Kaiser Family Foundation (KFF), 42 percent of those beneficiaries will be enrolled in Medicare Advantage (MA or Part C) plans by 2028. That’s an enormous potential market that you should focus on.

Medicare Advantage (MA) plans offer supplemental benefits that Original Medicare does not cover. Those benefits can include dental, vision, hearing, and fitness classes.

Why Sell Medicare Advantage Plans?

Medicare Insurance Agent - Senior Market Advisors

Typically, insurance carriers offer higher commissions for MA plans than Medicare Supplements or Part D plans. 

A Medicare Advantage plan may offer your client the lowest cost for the benefits they want. For example, some plans have $0 monthly premiums and they offer benefits Original Medicare does not cover such as gym memberships. 

Note: You’ll have the most sales success if you have all three products in your portfolio, because each type of plan serves different needs. For example, your clients may not want additional health benefits. A Medicare Supplement (Medigap) plan might work better for people who just want coinsurance or copays covered. Your clients cannot have both.

Selling SMART Podcast

Subscribe to our podcast and listen to “Episode 9: Why Sell Medicare Advantage?” for more information on why Medicare Advantage sales are so rewarding.

How to Sell Medicare Advantage Plans

Agent Meeting With Clients - Senior Market Advisors

Before you can start selling Medicare Advantage plans, you must receive the proper training, licensing, and certifications. Check with your state’s department of insurance to learn about state-specific requirements. After you’re licensed, the next step is marketing your services.

Licensing and Certification

First, you need to be licensed to sell Medicare plans in your state. Then you’ll need to contract with carriers. Most insurance carriers will require you to complete specific training along with AHIP certification

Marketing Medicare Advantage Plans

While you can market Medicare Advantage (MA)  plans yourself via direct mail, digital marketing, or traditional marketing (media buying), that can be costly and time-consuming. 

Another option is contracting with a Field Marketing Organization (FMO). Partnering with a FMO can mean you don’t have to spend your time creating marketing material and getting it out to your target audience. The right FMO can provide sales and marketing support to generate leads so you can focus on making sales rather than all of the behind-the-scenes work.

When you partner with a great FMO, you get access to MA plans from many carriers, rather than just one. That gives you the opportunity to offer your clients a variety of options and help them find the right fit. 

When Can I Sell Medicare Advantage?

Many Medicare-eligibles have restrictions on when they can enroll in new plans. You need to know the specifics of each enrollment period and how they apply to your clients.

Initial Enrollment Period

Many people qualify for Medicare when they turn 65. They have an Initial Enrollment Period (IEP) from three months before their 65th birthday to the three months after, which is a total of seven months to enroll in Medicare for the first time. People who qualify for Medicare who have ALS, ESRD, or who have received SSDI for at least 25 months can enroll before they turn 65. The IEP for those people is the month following their diagnosis or 25th SSDI payment.

General Enrollment Period

Clients who miss their IEP can enroll in a Medicare Advantage plan during the General Enrollment Period, which is from January to March. They may have to pay a penalty, and their coverage won’t start until July 1, however, so it’s important that they enroll when they first have the opportunity. Note: This IEP is only for beneficiaries enrolling for the first time.

If your clients want to enroll in a Medicare Advantage Prescription Drug (MAPD) plan or a Medicare Part D (prescription drug) plan, they can enroll from April 1 to June 30. Your client must have both Medicare Part A and Part B to enroll in a MAPD, but they only need Part A or Part B to enroll in a Part D plan.

Annual Enrollment Period

The majority of your clients will have to wait until the Annual Enrollment Period (AEP), which is from October 15 to December 7 to switch from Original Medicare to a Medicare Advantage plan.

Open Enrollment Period

The Open Enrollment Period (OEP) also lasts from January 1 to March 31, but the only Medicare Advantage change your client can make is switching from one MA plan to another MA plan. Your clients can also drop MA coverage and enroll in a Part D plan to go with Original Medicare.

This means that if your clients enrolled in a MA plan during AEP and they hate it, they can switch. For you, this means another three months of commission possibility. However, be careful — it also gives your clients a chance to disenroll and take your commissions away. It is crucial that you truly enroll  your clients in the best plan for them during AEP so that they don’t try to switch during OEP!

Plus, Medicare prohibits you from sending unsolicited marketing materials that mention OEP. You also aren’t allowed to target your AEP clients with mailings, calls, or other ways. You are, however, allowed to follow up with your AEP clients and ask how they like their plans. If they say, “I’m not happy with it,” you are allowed to meet and talk about plan options.

You are allowed to meet with your clients who enrolled during AEP if they explicitly ask for a meeting or information, however. You can also talk to someone about OEP if they ask about it. 

Special Enrollment Period

Other clients may qualify for a Special Enrollment Period (SEP) if they have certain life changes like moving, losing coverage, financial eligibility, or chronic illnesses. SEPs may be temporary or life-long. 

Clients with life-long SEPs may qualify for Special Needs Plans (SNPs), which are Medicare Advantage plans that are specific to certain health conditions and/or financial needs. They can make one change to their coverage per quarter from January to September. 

Clients who qualify for both Medicare and Medicaid may qualify for MA plans called Dual Special Needs Plans (DSNP). Those clients can make changes during AEP, but the new coverage won’t take effect until the following January, and you must code the change as AEP rather than SEP.

Selling Medicare Advantage Over the Phone

Sell Medicare Over the Phone - Medicare Plan Finder

You may have heard that you can sell Medicare Supplements over the phone, but you want to know how to sell Medicare Advantage plans over the phone. 

The first step is completing AHIP and obtaining the proper license in your state of residence. After you contract with Medicare Advantage carriers, you can sell by phone in your state any other state as long as you’re licensed in those states.

How Much Can I Make Selling Medicare Advantage Plans?

The Centers for Medicare and Medicaid (CMS) sets maximum compensation amounts that carriers can pay agents for sales. Click here to read more about agent compensation.

For contract year (CY) 2020, you can make up to $510 in most states for new Medicare Advantage enrollments. You can make up to $255 for MA plan renewals in most states. For California and New Jersey enrollments, you can make up to $636 for new enrollments and $318 for renewals. Connecticut, Pennsylvania, and District of Columbia sales can earn $574 for MAPD enrollments and $271 for renewals. 

Medicare Commissions - Senior Market Advisors

Medicare Commissions – Senior Market Advisors

Important Terms to Know When Selling Medicare Advantage Plans

You want to answer clients’ questions with confidence, so it’s important to know the terms they’ll ask about. Here are some common terms beneficiaries will ask about:

  • Appeal: A request for your health insurer or plan to review a decision or a grievance again.
  • Allowed Amount: The maximum amount covered for health care services. Sometimes called “eligible expense,”payment allowance,” or “negotiated rate.”
  • Balance Billing: When a provider bills the client for the difference between the provider’s change and allowed amount.
  • Co-Insurance: An amount the client is sometimes required to pay for health care services or prescriptions after a deductible.
  • Co-payment (Co-pay): An amount the client must pay as their share of the cost for health care services at the time of purchase.
  • Deductibles: The amount that the client will have to pay for health services or prescriptions each year before their insurance beings to pay.
  • Estimated Annual Cost: An estimate of the average amount the client might expect to spend each year for health coverage. The client’s out-of-pocket costs are based on typical health care for Medicare beneficiaries with the same age and health status. Also, if the client has limited income and resources, the client’s expenses may be lower. The estimate includes plan benefits (coverage) and costs for premiums, co-payments, deductibles, and co-insurance.
  • Estimated Annual Drug Cost: An estimate of the average amount the beneficiary should expect to pay each year for prescription drug coverage. This estimate includes monthly premiums, an annual deductible, drug copayments/coinsurance, and drug costs not covered by prescription drug insurance.
  • Out-Of-Pocket-Spending Limits: Protects the client by having yearly limits on their out-of-pocket costs for medical and hospital care. If the client reaches the limit on out-of-pocket costs, they continue to receive coverage for hospital and medical services. The insurance company will also pay the full cost for the rest of the year.
  • Provider Network: The group of providers who can provide health care services to plan members.

Start Selling Medicare Advantage Insurance Today

Selling Medicare Advantage plans can be a lucrative career. At Senior Market Advisors, we give our agents tools for success such as extensive training so you can answer questions with confidence.

When you contract with us, you get access to plans from all of the major Medicare Advantage carriers. That’s a huge sales advantage because that means you can suggest plans that best suit your clients’ needs, rather than just any plan. Our experienced marketing team can help generate leads so you can focus on closing sales rather than finding people to call. Ready to start? Call us at 1-844-452-5020 or eContract with us today.