68% of seniors are confused about Medicare coverage. It costs them billions.

71% of Medicare Advantage enrollees are satisfied with their plans, and a full 61% believe their plan outperforms previous coverage. But only 44% say they fully understand their plan, with 68% saying they’ve been confused by details like dental/vision/hearing coverage, out-of-pocket costs, transportation benefits, caregiver support, and home health services.

Worse still, 44% believe there is inadequate communication and education about the benefits they’re being offered. 1 in 4 beneficiaries report paying for services they believed to be covered by their plans. Another 10% believe they’ve been overbilled for services.

All told, 98% of seniors have some form of insurance – whether it comes from original Medicare, Medicare Advantage, or a retiree plan. Yet, they still carried $53.8 billion dollars in medical debt as of 2020.

Put simply, misunderstanding their coverage could lead your clients to incur unwanted, unnecessary, and even unwarranted bills. Here’s how you can help.

The pre-enrollment checklist is more than a formality

The first three items on the pre-enrollment checklist ask consumers to review the benefits in their Evidence of Coverage (EOC), whether their doctors participate with a plan, and the extent their prescription drugs may be covered. You’re likely doing a stellar job of the latter two; tools like CoverageForOne®, powered by SunFire®, allow speedy doctor and prescriptions checks across carriers. But, if you want to discuss the EOC in a context that matters, here’s a suggestion: take the time to sketch out the costs for a routine episode of care.

Perhaps the discovery process told you that your client is on an anti-depressant. Prescribing guidelines vary, but some doctors will require the patient to return every 6 months or fewer for a new round of labs (to ensure everything is functioning as it should), as well as a visit to discuss those results. So, with your EOC handy, you’ll be able to look at procedure and diagnosis codes and give the client a real-time example of how the plan will cover their costs. Even better, you’ve now shown your client how to do the same – empowering them to advocate for themselves.

Educate throughout the year

You’ve read in our other pieces how outreach throughout the year can net more customer feedback and create cross-selling opportunities. But, you could also take time to check in on your clients’ satisfaction with their plan. Are costs in line with projections? Have there been any surprises in what’s been covered – or what hasn’t been? A timely call could make the difference between a satisfied customer and a disgruntled one.

Another tool in your belt: Medicare marketing events. Hear us out.

Under CMS rules, a marketing event is one in which you discuss specific plans and plan details. While there’s some red tape to work through, scheduling a member-only event gives you an opportunity to talk about benefits with a larger crowd. Don’t underestimate the power of scheduling these events off-season. Even if you can’t make a sale right then and there, you’re adding value to your client relationships. And that will make them more likely to come back during AEP.

Help your clients understand coordination of benefits rules

Over two-thirds of seniors with medical debt have two or more sources of insurance. That makes billing and claims harder for providers and patients to navigate – and opens the door to lots of errors. Between 2020 and 2022, Medicare found 53% of complaints about debt collectors involved attempts to collect a debt that wasn’t owed. 

The most likely culprit? Coordination between Medicare and Medicaid for dual-eligible beneficiaries. While balance billing these beneficiaries is prohibited, that doesn’t mean it doesn’t happen.  And many beneficiaries see the fight with billing departments and debt collectors as hopeless. They end up shelling out cash they shouldn’t.

When your customers do have multiple sources of coverage, it’s essential to explain how they will (and won’t) work together. That could give them the reassurance they need to be better advocates for themselves.

Go the extra mile, build better relationships

We know. Everything we’ve just outlined takes the most valuable thing you have – time. But, it’s time invested in deepening your clients' knowledge and satisfaction with you. This type of extra effort could be what tips the scales when a client is deciding to pass along your business card.