Just because we are nearing the start of the lock-in period does not mean agents are safe from secret shoppers. CMS and plans conduct secret shops throughout the course of the year to ensure agents are conducting compliant sales events.
We took a look back on the secret shop results received over the past several months and have identified the most recurring trends causing agents to fail:
- Informal events, regardless if the event is public or private, may be secret shopped just like a formal event. These events require a sign to be posted that will notify a passing consumer the products what will be discussed.
- Formal events, regardless if the event is public or private, may be secret shopped. Agents are required to announce the product(s) that will be presented at the beginning of the event.
Sign in sheets
- Agents may not require consumers to provide any contact information as a prerequisite to attend an event. Sign-in sheets must clearly indicate that providing contact information is optional.
- Late Enrollment Penalty (LEP) for Rx plans
- Where to find and use the Plan’s formularies
- How to request an exception to the Plan’s formulary
- What is the ‘coverage gap’ also known as the ‘donut hole’ regarding Pharmacy
- Required to use a network pharmacy except in an emergency situation
- Agents did not state the plan’s overall star rating
- Agents did not indicate where to find the plan’s star rating in the material provided
Since Star Ratings seem to be still a little bit of a vague area for many agents, we have pulled together some tips to assist you when presenting plans in either a group or individual setting:
When presenting plans at an event or an individual appointment, you are required to say and do the following:
- State out loud where Star Ratings can be found
- State out loud what the Star Rating is for the plan(s) you are presenting
- Show the consumer where the Star Rating is located within the materials
- Tell the consumer they can find more information on www.Medicare.gov
- Mention 1-2 measures CMS considers when establishing a Plan’s Star Ratings
If you keep these things in mind when conducting your sales events and utilize the tools made available to you by the carriers, you should be in a good position to pass your next secret shop!