Hi, this is Robert  over here at Routt Insurance You recently spoke with someone in our  Medicare department and I'm the licensed Medicare enrollment specialist here to help you with the new plans available during this Medicare Open Enrollment. (quick pause) I know this can be overwhelming - you got a couple minutes?

 

(If they say no, say “ok <client name>, well i understand. I can set a time to connect later, but before I do let me tell you who I am and what I do...I work as a senior advocate…”)

 

Well I’m here to simplify your Medicare decision. Within a few minutes I’ll know if I can improve your situation and by the end of our call, you’ll be comfortable with your coverage. Do you have a pen and paper available?

 

Great! You’ll want to take down my contact information and write down the rates we discuss.

 

(If they don’t have it, offer to wait while they grab something to write with. Don’t present if they’re not ready to listen - ie. driving or out and about - schedule a call back.)

Who I Am and What I Do

 

Like I said before My name is Robert Routt and I’m licensed by the state to help you. Would you like my state license number?

 

I work as a senior advocate. I do NOT work directly for an insurance company, I work with the top companies like Mutual of Omaha, Aetna and Humana. This means I work for you to help you get the most out of your Medicare benefits.

 

I’ll be shopping your medicare every year to make sure you’re getting the most affordable and  benefit rich plans available to you.

 

So today I’m here to help you make an educated decision regarding your Medicare options, especially with all the changes the program has been going through lately. And just to be clear, there is no cost to you for my service, sound good? (Pause for response)

 

 

 

Discovery

Ok <Client Name> Let me verify the info i have in your file… I have your name spelled as                           _______________, right?

What is your date of birth?

What is your zip code? What county is that?

Does anyone else live in the household with you? (If hesitation, explain the discount)

  • What is their relationship to you?

  • What is their name?

  • What is their DOB?

  • Are they also on Medicare?

  • Do you make these decisions together or separate? (If together, ask if the other person can get on the phone right now and present to both)

If you have a “spouse in the house” you want to explain that you’ll help both make the best decision. Talk about the amount of money you can save the household.

 

Do you have an email address or a smart phone?

(if the answer is no, you know you’ll need to do a telephonic SOA if applying for Medicare Advantage)

Great! With COVID companies are allowing enrollment by email and phone to make things easy.

If you have an email or smart phone the enrollment process is very easy and I’ll walk you right through it on this call.

What kind of coverage do you have... Medicare Advantage Plan or a Medicare Supplement?

  • Can you do me a favor and grab your red, white and blue Medicare card as well as your plan card? …..No rush, I can wait.

 

 On your card, you have Part A and Part B start dates. What are those dates?

  • If no Part B, it will have just Part A dates.

  • Add to the CRM fields - you’ll need it for both med supp and medicare advantage application.)

    • If they can’t find their Medicare card, ask “Did you take Medicare when you turned 65?”

      • Medicare starts on the 1st of the month when someone turns 65. The exception is when their DOB falls on the first of the month. So get their DOB, add 65 years and work the math. This is how you back into the Part A and Part B dates if they don’t have their card.

 

If Medicare Supplement

What Company do you have your Medicare supplement with? What’s the plan letter?

What is your monthly payment?

Who do you have your Prescription coverage through? How’s it working for you?

(Important: run rates before moving forward to make sure you can lower their monthly cost)

  • If you can lower their rate, go immediately to the Existing Medicare Supplement Close.

  • If you can’t lower their monthly cost, congratulate them that they have the best rate.

    • Ask about dental/vision/hearing, final expense and other ancillary products.

    • Ask when they purchased their plan and set a follow up date 3 weeks before their annual increase. T

    • Tell them any time you receive a rate increase, give me a call immediately. Please

keep my contact information - save it in your phone or put it on your fridge.

 

 

If Medicare Advantage

 

What Company are you with?      What Plan are you on?

What is your monthly payment? (usually none) Who do you have your CoPay coverage with?

 

What do you like and dislike about it?

  • If they like their coverage, say “ok lets take a look at the new plans available” (and jump to the Existing Medicare Advantage Close)

    • If they dislike their coverage, say “what do you not like about your plan?”. (Move on to next question)

 

Are there any additional benefits that you’re not receiving that you would like? (actively listen for when you’re choosing a new plan and possible ancillary product sale)

 

Do you want to stay with a Medicare Advantage...or would you like to go back to original medicare with a supplement?

Important: If they want to go back to original medicare with a supplement, run rates real quick for the lowest price Plan G and the lowest price Plan N and quote them that range and ask if that’s in their budget. If it’s in their budget jump to Explaining Medicare part of the script.

 

  • If not within their budget, find them a better Medicare Advantage plan and jump to the

Existing Medicare Advantage Close.

  • If they want to stay on Medicare Advantage, jump to the Existing Medicare Advantage Close

    • If you can lower their med sup payment, move on to Explaining Medicare section. Do you receive any extra help from Medicaid or any extra help on prescriptions?

(if yes, review Extra Help page in portal for direction)

 

If New To Medicare - move on to “Explaining Medicare” below

 

 

Explaining Medicare

Always give a brief explanation of Medicare, even if they think they know what they want. Let me recap the basics of Medicare here.

There are 2 original parts of Medicare.

 

  • Part A: This is your hospital coverage. This is what you paid into while you were working. There’s no additional cost for this.

(Common question: If your spouse worked enough, you also don’t have to pay for Part A)

  • Part B: is your doctor’s visits, lab work, x-rays, outpatient services etc. This is what comes out of your social security check - the average person pays $144.60/mo. Part B also has an annual deductible of $198.

Together Part A and B cover you at 80%, are you with me? With that said, there are 3 main concerns my clients have:

 

  1. Prescription drug coverage also known as Part D. Don’t worry about that right now, we’ll come back and visit that later on.

  2. Dental / Vision / Hearing and cancer coverage. Most Dental / Vision / Hearing costs are not covered by original medicare Parts A&B and cancer can be financially devastating. These are simple problems to fix and we’ll revisit them at the end of the call.

  3. The deductibles and 20% out of pocket co-pays in original Medicare. This will be our primary concern.

 

Does all that make sense?

Let’s review your options <Client Name>.

Medicare Advantage or Medicare Supplement?

Note: This section is for those who are new to Medicare (ie open enrollment) or are undecided on which direction to go.

 

I want you to draw a line separating the two sides of your paper. What we’ll write down here is going to help you decide how you want to take care of the biggest out of pockets from Parts A&B. On the left side put “Medicare Advantage.” This is also known as Part C. People are often surprised to find they can reduce their out of pocket expenses for little or no additional premium. Let me explain how that works.

With Medicare Advantage, a private insurance company will be responsible for handling your claims with Medicare.

These policies look a lot more like the policies you had while you were working. You’ll have doctors’ networks, deductibles, out of pockets, that kind of thing. To make it simple, I like to call this “Pay as you go” insurance. Mark down “Pay as you go” on your paper for me.

 

With this policy you don’t pay as much (or anything) monthly, but you’ll owe more when you use the coverage. These plans even often include your Part D prescription coverage.

Each company has different plans with different options based on your choices. I’m here to make sense out of the options for you.

Do you feel like you understand the, “Pay as you go” option? (Wait for answer)

The Second Option is...

A Medicare Supplement plan. Write that down on the other side of your paper.

Medicare Supplements work with Original Medicare Parts A & B. There are no networks or referrals like you have with Medicare Advantage.

 

 

People often like this benefit, because if you get cancer or some other major health condition, you can go to the hospital or doctor of your choice, as long as they accept Medicare (The largest network you’ll find). I like to call these plans the, “pre-pay plans,” because you pay the premium up front and will have minimal out of pocket expenses as you use your coverage. As you can see they’re much easier to navigate than Medicare Advantage. Go ahead and put “pre-pay plan” next to Medicare Supplement.

One great thing about this coverage is the fact that back in 1992 all of these policies were standardized. They standardized the plans, the benefits, and the doctor’s networks. Here’s what that looks like:

  1. The Plan Letters have been standardized. For example, “Plan G” with Mutual of Omaha is the same as “Plan G” with Aetna. The company doesn’t matter, only the plan letter. They offer the exact same benefits.

 

  1. The Doctor’s networks have been standardized. Unlike Medicare Advantage, doctors who accept Medicare must accept any Medicare Supplement company. The Medicare agreement requires it.

 

The only thing that is not the same with each company is the price. The policies are guaranteed renewable - meaning as long as the company offers coverage and you pay the premium, you can continue coverage with them regardless of your current health.

Now, the Drug Plan is not included, and you will need to get a Part D drug plan. I can help you do that after we get your primary policy taken care of.

Does the “Pre-pay Plan” make sense? (Wait for answer)

Which of these two options fit you the best - “Pay as you go,” or a, “Pre-pay plan”? (Wait for answer)

 

Move to either “New To Medicare Advantage Close” or “New To Medicare Supplement Close”.

 

New To Medicare Advantage Close

Wonderful, now, my job is to sort through all the plans in your county and build coverage around YOUR doctors and YOUR medications to make sure we find the right plan for you.

Recap their requests for them (what they wanted in a policy)

Now, <client name>, I see some OUTSTANDING options for you that likely won’t cost you anything. Let’s make sure we find one that meets all your needs including covering your current doctors and prescriptions.

 

Due to the regulation around Medicare, I do need you to sign something giving me permission to review the details of the plans for you. When we sign this document, I recommend you check every box, for each product so that I can evaluate every option for you. You’re not signing up to obtain anything yet, just signing off that you understand the kinds of products we will be discussing.

Get the SOA – Verify the products included. SOA can be done via Text or Email through SunFire (Medicare Link).

For Telephonic SOA: If you have to do a carrier direct SOA (for telephone SOA) get the medications and doctors first, don’t share plan details, but determine the best plan so you can complete the telephonic SOA.

 

After you get the SOA, proceed to the next questions:

What is your doctors name? Do you regularly see any specialists?

 

Would you like me to review your prescription prices with you to make sure we’re considering your estimated cost for your prescriptions with the plan?

If yes, calculate the cost of the prescriptions by adding them into MedicareLink. Review with client.

It’s fine to put the client on hold while you’re looking into it.

 

Company Presentation (offer 1 MA plan only)

 

Everything is looking good. (pause) I’m reviewing the available plans in your area.

 

So, <Client name> the plan in your area that best suits your needs is: <Company Name> let me tell you about some of the plan benefits:

 

  1. All of your doctors are in network. How does that sound?

  2. This policy keeps your prescription cost low. .

  3. (if 4 Star Rating or better) Consumer reviews are done through Star Ratings and this plan has an above average star rating.

  4. This plan also includes the additional benefits you were looking for. Will that work?

 

And best of all <Client Name>, there’s no cost. Isn’t that awesome! Now lets review the Summary of Benefits and the Star Rating.

Review the Summary of Benefits and Star Rating Guide (these must also be sent to the client).

 

Now, as you can see, there are out of pocket expenses. I always advise my clients to take out a small supplemental policy to help cover these costs. We won't get into it right now, but we’ll cover it before the end of the call, first let’s get this plan in place.

Write MAPD Policy NOW

 

Cancer and HIP Add On (After MAPD app complete)

Add in a Cancer and HIP policy for the first offer, if too much, drop to MAPD and Cancer. Skip if they’re on Medicaid.

I don’t know if you’ve ever had a family member with Cancer. It is traumatic. (pause and share a story)

 

Not only that, it is expensive. And statistics tell us that 1 in 2 men and 1 in 3 women get cancer at some point. Because of this, I add cancer coverage for all of my clients. This is a lump sum payment that you can use to cover your copays, chemo and any costs.

I also recommend a Co-pay policy to help with your out of pocket expenses. This policy reimburses the costs of going to the hospital and protects you from a good amount of your out of pocket costs.

 

$10,000 in cancer coverage and your “Co-pay Insurance” costs $          / month. Does that sound like it covers everything you were looking for?

If the client scoffs at the price of Copay (HIP) and Cancer coverage, review the out of pocket

costs and make sure they’re comfortable with those. Ask who will be responsible for those costs. If children or a loved one, ask if they should discuss the cost of optional coverage/ Supplements with them.

 

You should be able to attach HIP and/or cancer policies to 70% of MAPD plans assuming there's no Medicaid.

Wonderful. Today we’re simply submitting the paperwork for the policy. Your policy will start on

<start date>. You will continue paying any part A and B premiums directly to Medicare. (If there’s a cost for Advantage say, “You can pay your additional premiums directly to <company>”

Complete Application

Save plan details in a file for future reviews

Button Up

 

OK <Client Name>,

 

You made a great decision with choosing the <company name> plan. This will be your new plan starting <start date>.

I’m going to reach out in a few weeks just to confirm you received your plan packet and card.

 

From here on out, I’m your agent. Any questions or concerns, always call me first. If you see an advertisement on TV, get a letter in the mail or talk to a friend or family and you have questions

- just call me. I recommend keeping my name and number on your fridge or somewhere you keep important information.

 

Also, please don’t keep me a secret. I really enjoy helping people with their Medicare benefits. By chance, can you think of anyone right now who needs help with their medicare?

 

I know we’ve spent a while on the phone today and you’ve processed a lot of information. I’m scheduling a call on my calendar to follow a few weeks before your renewal in 1 year.

 

Have any other questions? Have a great day!

 

Existing Medicare Advantage Close

Ok <client name>,we’re going to take a look at the new options in your area. We’ll find one that meets all your needs and covers all your doctors and prescriptions.

 

Due to the regulation around Medicare, I do need you to sign something giving me permission to review the details of the plans for you. When we sign this document, I recommend you check every box, for each product so that I can evaluate every option for you. You’re not signing up to obtain anything yet, just signing off that you understand the kinds of products we will be discussing.

 

Get the SOA –Verify the products included. SOA can be done via Text or Email through SunFire (Medicare Link).

For Telephonic SOA: If you have to do a carrier direct SOA (for telephone SOA) get the medications and doctors first, don’t share plan details, but determine the best plan so you can complete the telephonic SOA.

 

After you get the SOA, proceed to the next questions:

What is your doctors name? Do you regularly see any specialists?

 

Would you like me to review your prescription prices with you to make sure we’re considering your estimated cost for your prescriptions with the plan?

If yes, calculate the cost of the prescriptions by adding them into MedicareLink. Review with client.

It’s fine to put the client on hold while you’re looking into it.

 

Company Presentation (offer 1 MA plan only)

 

Everything is looking good. (pause) I’m reviewing the available plans in your area.

 

So, <Client name> the plan in your area that best suits your needs is: <Company Name> let me tell you about some of the plan benefits:

 

  1. All of your doctors are in network. How does that sound?

  2. This policy keeps your prescription cost low. .

  3. (if 4 Star Rating or better) Consumer reviews are done through Star Ratings and this plan has an above average star rating.

  4. This plan also includes the additional benefits you were looking for. Will that work?

And best of all <Client Name>, there’s no cost. Isn’t that awesome! Now lets review the Summary of Benefits and the Star Rating.

Review the Summary of Benefits and Star Rating Guide (these must also be sent to the client).

 

Now, as you can see, there are out of pocket expenses. I always advise my clients to take out a small supplemental policy to help cover these costs. We won't get into it right now, but we’ll cover it before the end of the call, first let’s get this plan in place.

Write MAPD Policy NOW

 

Cancer and HIP Add On

Add in a Cancer and HIP policy for the first offer, if too much, drop to MAPD and Cancer. Skip if they’re on Medicaid.

I don’t know if you’ve ever had a family member with Cancer. It is traumatic. (share a story)

 

Not only that, it is expensive. And statistics tell us that 1 in 2 men and 1 in 3 women get cancer at some point. Because of this, I add cancer coverage for all of my clients. This is a lump sum payment that you can use to cover your copays, chemo and any costs.

I also recommend a Co-pay policy to help with your out of pocket expenses. This policy reimburses the costs of going to the hospital and protects you from a good amount of your out of pocket costs.

 

$10,000 in cancer coverage and your “Co-pay Insurance” costs $  ______/  month. Does that sound like it covers everything you were looking for?

If the client scoffs at the price of Copay (HIP) and Cancer coverage, review the out of pocket

costs and make sure they’re comfortable with those. Ask who will be responsible for those costs. If children or a loved one, ask if they should discuss the cost of optional coverage/ Supplements with them.

You should be able to attach HIP and/or cancer policies to 70% of MAPD plans assuming there's no Medicaid.

Wonderful. Today we’re simply submitting the paperwork for the policy. Your policy will start on

_start date_. You will continue paying any part A and B premiums directly to Medicare. If a cost for Advantage, “You can pay your additional premiums directly to <company>”

 

Complete Application

Save plan details in a file for future reviews

 

Button Up

 

OK <Client Name>,

 

You made a great decision with choosing the <company name> plan. This will be your new plan starting <start date>.

I’m going to reach out in a few weeks just to confirm you received your plan packet and card.

 

From here on out, I’m your agent. Any questions or concerns, always call me first. If you see an advertisement on TV, get a letter in the mail or talk to a friend or family and you have questions

- just call me. I recommend keeping my name and number on your fridge or somewhere you keep important information.

 

Also, please don’t keep me a secret. I really enjoy helping people with their Medicare benefits. By chance, can you think of anyone right now who needs help with their medicare?

 

I know we’ve spent a while on the phone today and you’ve processed a lot of information. I’m scheduling a call on my calendar to follow a few weeks before your renewal in 1 year.

 

Have any other questions? Have a great day!

 

New To Medicare Supplement Close

Great decision! Tell me why this option was so important to you? (affirm decision)

I need to ask a few medical questions to identify which company would be a good match for you. (If open enrollment no need for medical questions)

 

See Med Supp Health Questionnaire Addendum

 

Wonderful, the 3 most popular Supplement Plans are Plans F, G , and N.

 

Let's look at plans and rates right now and see what makes the most sense.

(Run rates: Quote Plan F if qualified, drop down to Plan G if too expensive, then to Plan N)

If they qualify for Plan F: Plan F has no out of pocket costs. For example, if you’re able to qualify, a rate for you through <Company> would be <price> or <Company 2> would be <price 2>. Which of these makes the most sense for you?

 

(If yes) Great decision, now as your advisor, I want you to be aware there is a plan that is a little less expensive with a small deductible. Would you like to hear about that plan? If Yes, go to plan G, if no Take the app for F.

If they don’t qualify for Plan F: Plan G is a great plan. It is the most comprehensive plan you qualify for. transition to G: Plan G covers all of your out of pocket expenses with a small $198 annual deductible. Once you meet your $198 annual deductible you won’t see any more bills for the rest of the year. if you’re able to qualify, a rate for you with Plan G through <Company> would be <price> or <Company 2> would be <price 2>. Which of these makes the most sense?

Great choice! Only move to a plan N if they are not happy with the price of Plan G

(if showing plan N, say this) If you were to select a Plan N you could or may be responsible for a

$20 copay at the doctors office….or a $50 copay at the emergency room. You could or may also be responsible for excess charges - which are very rare. If you’re able to qualify, a rate for you through <company> would be <price> or <company 2> would be <price 2>.

 

Based on this information, would a Plan N or Plan G work best for you?

 

Great decision! That’s what I would want for you if you were my mom or dad.

 

Start Application

 

Dental/Vision/Hearing Add On (After Med Supp App Complete)

 

 

As we discussed earlier, Medicare doesn’t cover routine dental, vision and hearing so I recommend my clients who get a supplement also get a dental / vision / hearing plan. Would you like to hear more about this plan?

 

(if yes) Ok so let me tell you about the benefits of the Manhattan Life dental, vision, hearing plan.

There’s no network … you can see any dentist, optometrist, audiologist in the U.S. you want. So you do not have to worry if your provider takes the plan.

This plan covers you at 60% the first year, 70% the second and 80% the third and then stays at 80% for the lifetime of the policy.

There is a small annual deductible of $100 , but that applies to all the services , you do not have to pay it separately for dental, vision and hearing.

The day the policy starts you can be reimbursed for your basic dental services such as semi-annual cleanings, x-rays, fillings, and extractions (excluding full mouth).

After 6 months your eye exam , glasses and contact lenses are covered.

 

Then after 1 year all your major dental is covered such as bridges , crowns , full and partial dentures, root canals, and full mouth extractions, as well as new hearing aids.

 

Best of all, there’s no contract.

 

The price is only <$ > for a $1,500 dental/vision/hearing policy…or only <$ > for $1,000 with a $100 deductible with Manhattan Life. Do you think a $1,500 policy or a $1,000 policy would work best for you?

 

Complete Application

 

Cancer Add On

 

I don’t know if you’ve ever known anyone with Cancer. It’s traumatic right? (pause and share a story)

 

Not only that, it’s expensive. And statistics tell us that 1 in 2 men and 1 in 3 women get cancer at some point. Because of this, I add cancer coverage for all of my clients. This is a lump sum payment that you can use to cover your copays, chemo, prescriptions and any additional costs.

Does the cancer policy seem like something you’d be interested in?

 

Complete Application

Part D Add On

 

I told you before that we would take a look at your Part D plan for prescription coverage as well.

 

I’ll need you to sign off on our ability to discuss this plan. Would you like me to help you with this policy?

Get SOA

Enter prescription information into Sunfire and help the client decide on the right Part D for them based on total costs.

Now, I want to explain to you briefly how a Part D plan works. There’s 2 separate deductibles with a coverage gap in the middle and catastrophic coverage at the end. Most of my clients never enter the coverage gap. This can seem overwhelming, but my approach is to take your particular prescriptions, with your pharmacy of choice and to help you estimate your annual cost. Is it ok if I help you estimate that cost?

If yes, enter prescriptions and offer the best plan.

If a client doesn’t have many or any prescriptions, let them know that you’ll help them find a low cost policy that will protect them for the future and help them avoid the penalty.

Explain the Coverage Levels (donut hole) Take Part D application

Button Up

 

OK <Client Name>,

 

You made a great decision with choosing <Plan X> with <company name>. Upon approval, this will be your new plan starting <start date>.

You should receive your packet and plan card in 5-10 business days after approval.

 

(If open enrollment, there’s no phone interview - skip this paragraph) <Insurance Company> may call you for a phone interview. If you miss their call, they’ll leave a message. Please return their call - it’s required for approval if they reach out.

 

Great. From here on out, I’m your agent. Any questions or concerns, always call me first. If

 

you see an advertisement on TV, get a letter in the mail or talk to a friend or family and you have questions - just call me. I recommend keeping my name and number on your fridge or somewhere you keep important information.

 

Also, please don’t keep me a secret. I really enjoy helping people with their Medicare benefits. By chance, can you think of anyone right now who needs help with their medicare?

 

I know we’ve spent a while on the phone today and you’ve processed a lot of information. I’m scheduling a call on my calendar to follow a few weeks before your renewal in 1 year.

 

Have any other questions? Have a great day!