Rapid Disenrollments occur when Medicare beneficiaries voluntarily leave a plan before enrollment is final or within three months of their effective date. Rapid Disenrollments will result in a full chargeback of the agent’s commission and may even result in compliance issues if an agent’s Rapid Disenrollment Rate is high enough. There are many reasons why a beneficiary may disenroll from a plan within the first 90 days, but there are several things you can do as an agent to minimize the number of Rapid Disenrollments you have.
During the Appointment:
1. Ensure all doctors (primary care physicians and specialists) and hospitals the member wishes to use are in the network.
While you may choose to use a paper copy of the Provider Directory, these publications change frequently so it is recommended the agent either use the online version or contact Agent Support with the carrier for confirmation whenever possible.
Thoroughly explain what will happen if the member goes out of network.
2. Utilize the Formulary.
Verify that all medications the beneficiary gives you are included in the formulary and confirm the tier and copay for each. Make sure he/she understands step-therapy, exceptions, etc. for medications that are not in the formulary or that have quantity limits. Also, explain any deductible that is included.
3. Verify Extra Help.
Confirm whether or not the member receives extra help from Medicaid or another assistance program and, if so, which level of assistance they are on. Verify that their plan option coordinates with the level of extra help they receive as some Medicare Advantage and/or Part D plans do not.
4. Prepare the Client for the Outbound Enrollment Verification Call.
Carriers see the majority of rapid disenrollments stem from OEV calls. This is often because the member does not understand the questions they are being asked or has forgotten everything that was covered during the appointment and not because they are generally dissatisfied with the plan. Prepare your clients for the OEV call by spending a few minutes at the end of each appointment covering the items that will be discussed on the call. Some carriers even provide a checklist that you can leave with the members for them to reference during the call.
After the Appointment:
Don’t let communication between you and your clients end after the sale is made. Follow up with them to ensure they feel comfortable with their plan choice and with you as their agent. Below are just a few things you can do to follow up after the appointment:
- Follow up with the carrier to make sure the plan is issued and that the member is assigned to the correct plan with the correct effective date. Most carriers have online tracking tools that agents can use to help with this.
- Make sure the member receives their Member ID card and that they understand how to use the card and the plan.
- Revisit any questions they might have about networks or formularies.
Encourage the member to contact you with any questions or concerns they have, instead of the carrier or Medicare – this can not only strengthen their relationship with you, but also helps cut down on sales allegations.