Reasons Why Clients Switch Medicare Plans During AEP

Written by Lexi Williams

October 26, 2020

Now that Medicare Annual Enrollment Period, (AEP) is here, you have likely reviewed the majority your client’s coverage options to determine if their coverage continues to meet their medical and financial needs. Around 10% of Medicare Advantage (MAPD) enrollees switch plans each year. If you’re a new Medicare agent, a common occurrence you may face in the AEP varies with beneficiaries, and their current plan may no longer fit their lifestyle or budget. Because Agent Pipeline is dedicated to helping insurance agents grow and develop their professional skillsets – we’ve worked with some of the top producing Medicare agents to help you get a better understanding of why beneficiaries change coverage during the AEP.

Cost of Coverage

According to many of our experience Medicare insurance agents, a common reason for beneficiaries to switch coverage is their current Medicare health plan does not fit in their budget. Beneficiaries could be missing out on equal coverage at a lower monthly premium. One of the primary roles of a Medicare insurance agent is to help beneficiaries compare plans to ensure they have the coverage that makes the most sense. If you’re a new Medicare agent, try asking your Medicare beneficiaries questions like:

  • Does your current Medicare health plan charge a monthly premium in addition to your Part B premium?
  • How much do you pay in copays?
  • Does your current Medicare health plan have an annual deductible?
  • What’s your maximum out-of-pocket cost?
  • Is your network restricted?
  • Are your preferred doctors in your current network?
  • Do you have a prescription drug plan? If so, are your current prescriptions covered?
  • Are there any additional benefits on your current Medicare health plan that you must-have if you switch?

We know too often change is inevitable. Sometimes your beneficiary’s healthcare needs may change, requiring different coverage. Depending on their specific situation, they may make changes outside of AEP during the Special Enrollment Period (SEP). However, during the AEP, also known as the Annual Enrollment Period, your beneficiaries have the freedom to make the following changes to their Medicare Health plan:

  • Change to a Medicare Advantage plan (Medicare Part C) from Original Medicare (Parts A and B)
  • Change from a Medicare Advantage plan (Medicare Part C) to Original Medicare (Parts A and B)
  • Enroll in a Medicare Supplement (also known as a Medigap policy) to pair with Original Medicare Part A & Part B
  • Change Medicare Advantage plans (Medicare Part C)
  • Enroll in a new stand-alone Part D plan
  • Change to a different stand-alone Part D Plan
  • Opt-out of a prescription drug plan (PDP), if they have enrolled in a new Medicare Advantage (MAPD) plan which includes prescription drug coverage

Star Ratings

The star rating system is in place to help beneficiaries determine where their current plan and prospective plans rank on a scale of 1 to 5 stars. Medicare insurance agents can help beneficiaries by looking at star ratings and explaining what they mean. When you review this information with your beneficiaries, it may reveal better quality coverage is available in their plan’s area.

  • The Star rating system is based on:
  • The accuracy of plan pricing
  • Customer service
  • Frequency of problems and amount of complaints
  • Member experience
  • If members with chronic conditions received the recommended tests and treatments to manage their health

Many Medicare insurance agents see AEP only as an opportunity to enroll new Medicare beneficiaries into a Medicare health plan for the first time. However, it’s crucial to provide high-quality customer service to your current clients and ensure they have the right Medicare health plan which meets their medical and financial needs for the upcoming year.

If you’re an insurance agent new to Medicare, don’t fret! Agent Pipeline experts are here to help you understand the plan options available in your market and understand how to compliantly enroll and support beneficiaries during this AEP.

As a top Medicare FMO, Agent Pipeline offers Medicare insurance agents with no-cost technology including free quoting, enrollment and CRM resources; compliance programs to ensure you avoid sales allegations & market to beneficiaries in your area in according with the Medicare Marketing Guidelines; and to ensure you’re equipped with the most competitive products available in your market.

In addition to ensuring you are equipped with the most competitive Medicare products in your portfolio, our marketers can help support you by providing cross-selling opportunities, products, and exclusive training sessions! We can’t wait to help you reach your goals, financial success and have your best AEP yet.

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