Every client you come across has a specific set of needs that they want to be met by their health coverage. With all the options available to consumers, how do you know which plans are best suited for them? The answer is simple – ask questions and perform a thorough needs assessment.
A proper needs assessment will cover the basic needs of any client and help you discover which types of coverage your client needs the most.
JSA has put together a list of key questions to ask when conducting a needs assessment with a potential client.
- Is the consumer enrolled in Medicare Part A and Part B?
Knowing if and when a client has enrolled in Part A and Part B will help you determine some key things: whether or not the client is eligible for any Medicare Health Plans, if a consumer is in the initial enrollment period (IEP), or if he/she is in the open enrollment period for Medicare Supplement Plans.
- Where is the consumer’s permanent residence?
This will determine which plans are available for your client.
- Has the client lived in his/her home for over 3 months?
A recent move may open up a special election period (SEP), or even a guaranteed issue (GI) situation, for the client to enroll into a new plan.
- Does the consumer travel to or live in another state during the year?
If the consumer travels, you may want to look at a plan that includes a travel benefit or flexibility in provider choice. Medicare Supplement plans, PPO’s, and even some HMO plans include coverage for members when they are away from their primary residence.
- Does the consumer take any medications?
All drug formularies are different, so knowing your client’s drug list is extremely important. Enrolling a client in the wrong Part D or MAPD plan could cost a consumer hundreds, or even thousands, of dollars per year.
- Does the client receive assistance from the state or carry a Medicaid card?
If a consumer has Medicare and Medicaid, he or she may qualify for a Dual Special Needs Plan (DSNP), which will help coordinate their Medicare and Medicaid benefits. DSNP plans often cover benefits that are above and beyond what Original Medicare and Medicaid offer.
- Does your client have any chronic conditions?
Depending on the conditions, your client could qualify for a Chronic Special Needs Plan (Chronic SNP). Chronic SNP Plans are designed to help treat conditions like diabetes, chronic heart failure , and coronary artery disease.
- Does the consumer have a Primary Care Doctor or a Specialist?
When offering network-based plans to clients, it’s very important to ensure that their physicians participate in the plans’ networks.
JSA’s Client Needs Assessment form is below. Make this a part of every initial sales appointment to ensure you’re getting all of the information you need to recommend the right plan for each client. And be sure to keep the form for your files, in case any questions come up after the sale.