Canceled applications will count against you when your compliance in the sales process is measured. These, rapid disenrollments, late applications, member complaints, and PCP auto-assignments all will count against your compliance measurements. Thankfully, you know this and can prepare for this by taking steps to reduce canceled applications.
Canceled applications are submitted applications that the client cancels before the application’s effective date. The top reasons for canceled applications include inaccurate provider network information, inaccurate drug formulary information, inaccurate cost or benefit information, unsuitable plan enrollment, and client confusion with the plan.
Provider Network Information
Health Maintenance Organizations, Health Maintenance Organization Point-of-Sale, and Preferred Provider Organizations are types of Medicare Advantage plans that typically use networks of contracted healthcare providers. Verify that your client’s providers are participating in the recommended Medicare plan, and check whether they will be in-network or out-of-network providers. Let the client know if the plan requires a primary care physician or referrals to see a specialist.
Drug Formulary Information
For Part D prescription drug plans and Medicare Advantage Prescription Drug plans, check that your client’s medications will be covered under the plan’s formulary. Explain the tier system and the plan uses preferred pharmacies. Cover the cost sharing of premiums, copayments and coinsurance, the coverage gap, catastrophic coverage, the Part D penalty, and any subsidies the client may be eligible for through the state.
Cost Information
Explain all costs associated with the plan accurately and thoroughly to make sure the client fully understands all costs involved. If this involves any zero dollar premiums, do not call them “free.”
Benefit Information
Discuss all benefits of the plan and verify the client’s understanding of which benefits are covered and not covered. Explain any gaps in coverage for dental or vision, for example.
Plan Suitability
Make sure that the plan you recommend is the best option for the client. Consider provider coverage, costs and medications, and the priorities of your client.
Client Confusion
Explain the coverage and costs of the plan thoroughly. Go through the Summary of Benefits page by page and ask the client if they have any questions. Encourage the client to direct any questions to you or to the carrier.
Dual eligible Medicare and Medicaid beneficiaries generally make up more of the canceled applications because of the flexibility to change plans at any time. Be sure that the plan these clients sign up for is truly the best available option to meet their needs.
