Overview
The goal is to get the participant’s buy-in to speak with a licensed agent who will assess their current situation and provide guidance on enrollment into parts B, C, & D. Warm transferring should be the first priority. Schedule an appointment if transferring is not an option.
Participant is 65+ years old:
These participants are enrolled into part A along with group coverage. They have the option to drop group coverage and enroll into Medicare part B along with a Medicare Advantage plan or a supplement + PDP.
“Hello, may I please speak with _____? Yes, this is ____ calling from Medicare Transition Services. We are working with your employer to educate employees on Medicare options available and to help determine if Medicare is a good fit. The call will only take a few minutes and together we can ensure you are taking advantage of all the benefits you are entitled to.”
Participant is within the 3 month SEP age-in enrollment window prior to turning 65:
These participants have an SEP and are usually dropping group coverage to enroll into Medicare A & B along with a Medicare Advantage plan or a supplement + PDP.
“Hello, may I please speak with _____? Yes, this is ____ calling from Medicare Transition Services. We have received notice that you have recently had a change in your employer medical coverage. The purpose of this call to review your current status to ensure there are no gaps in your health coverage. We can also review Medicare options available and to help determine if Medicare is a good fit. The call will only take a few minutes and together we can ensure you are taking advantage of all the benefits you are entitled to.”
Agent reviews reason for the call. To provide the member with information on Medicare options and to help the member determine if moving to Medicare may be a good fit.
Agent informs member that during the call he or she will provide a high level overview of how Medicare works and answer any questions the member may have.
Demographic Information
TA confirms demographic information on file (DOB, Home Address, Alternate Telephone Numbers, email)
Set the Agenda
Agent provides information to the member on what we do in our department. That we work with customers to provide options available to those eligible for Medicare who are either still actively employed or approaching/in retirement. We offer to review plans in the area for comparison against the member’s current employer group plan. We also will answer all questions along the way.
COBRA (Term Coverage)
Review COBRA rules/Medicare implications on coverage.
Health Savings Account
Agent reviews important rules on HSA and Medicare.
Dependents
Agent asks about any dependents that may be on the plan.
Wages and Part B/D Premiums
Agent confirms wages from 2 years ago and confirms Part B/D premium based on this information.
Medicare Review
Agent provides high level review of Medicare, including Parts A, B, C, and D. Agent also reviews Medicare Supplement.
Medicare Parts A and B
Agent determines members status in parts A/B.
Scope of Appointment
Agent confirms Scope of Appointment, which is a review of what will be discussed. Medicare requires this step whenever a review of plans is to occur.
Plan Comparison – Agent reviews Medicare plans in the members vicinity. The member may not know their plan benefits and limits. In such cases, the agent will review plans in the area and provide details that the member may compare once his or her plan details are discovered.
Agent will review the differences between HMO and PPO plans. Agent conducts a network review to ensure the member’s doctors and hospitals are participating.
Agent provides the name of the plan and the plan carrier. (Humana, United Health Care, Aetna, etc.)
Agent provides premium
Agent provides costs for primary care visit, specialist visit, various tests and procedures.
TA and prospect discuss any cost benefit to the prospect.
Agent reviews the associated coverage levels of any prescription drugs being taken by the member.
Agent reviews plan deductible, Maximum Out of Pocket and costs for services such as surgery and tests such as an MRI.
Prospect Decision
Member and Agent review next steps. Will Medicare benefit the member? If yes, and the member already has part A/B, the agent will offer to enroll in the Medicare plan. If the member does not yet have part A/B agent reviews how to apply for Medicare.
Schedule a Call Back
If necessary, the agent will offer to schedule a call back at the member’s convenience to ensure the member stays on track.
Journey Map
The agent offers to send a Journey Map to the member.
Call Closing
Agent closes the call.