Selecting the ideal Medicare Part D plan requires more than just a basic overview. With each client’s unique medication needs and budget, it’s important to dive into the details to find a plan that truly fits. Follow these four steps to help guide your clients toward the most cost-effective and convenient prescription drug coverage.
1. Prepare Your Portfolio
Before recommending any plan, it’s essential to have multiple options in your portfolio. A well-rounded selection allows you to match specific plans to each client’s needs. Start with a portfolio review with NIM to see if you should add any other carriers.
Once you know which plans to add, you need to get contracted with each carrier and complete their training to be ‘Ready to Sell’.
2. Collect Your Client’s Prescription Information
Before meeting with your client, gather a full list of their current prescriptions, including:
- Drug name, dosage, and how often they take it
- Preferred pharmacy or preference for mail delivery
These details are crucial, as formularies categorize drugs by specific usage and dosage. Using an intake form or app, such as RetireFlo, simplifies this process by integrating with Connecture. By inviting clients to input their own drug information, you’ll save an immense out of time. Just review the details with them to confirm accuracy.
3. Use Connecture to Compare Plan Options
Once you have all your client’s information, you can run a custom quote in Connecture. This tool lets you compare Part D plans based on premium, formulary, deductible, and pharmacy preference, so you can find the plan that best fits their needs.
When comparing Part D plans, focus on these three main factors:
Formulary
Each Part D plan has a formulary that organizes drugs into 5 tiers. Generic drugs are generally in lower tiers with lower costs, while brand-name drugs are in higher tiers and may require higher copays. Checking the plan’s formulary is essential to ensure that the client’s medications are covered at a reasonable price. If they’re open to switching to generics, this could be a cost-saving option.
Premiums and Deductibles
PDP premiums and deductibles can vary significantly. Some plans have no deductible on lower-cost tiers, while others may charge up to the maximum CMS-allowed deductible across all tiers. Although clients may favor plans with lower premiums, ensure they can comfortably manage any deductible costs, especially if they’re on a fixed income. The Medicare Prescription Payment Plan is an option that allows clients to spread out medication costs over time, which can ease the burden of high upfront expenses.
Network
PDPs work with a network of pharmacies that offer preferred rates. If your client has a preferred pharmacy, it’s essential to confirm that it’s in-network or, even better, a preferred pharmacy. This can provide additional savings and convenience.
4. Make a Personalized Recommendation
After comparing plans, it’s time to make your recommendation. With each client’s needs in mind, select a plan that aligns with their specific location, income, and medication requirements. Since each client’s needs are unique, it’s wise to have contracts with several carriers in your area to accommodate a variety of situations. Regularly reviewing and updating your portfolio also ensures you’re offering the latest options.
By following these four steps, you’ll be well-prepared to recommend a Medicare Part D plan that aligns with your client’s needs and budget, ultimately ensuring they receive the best possible coverage for their medications.