When you discover a consumer is already enrolled in a Medicare Advantage plan, what must you do prior to making a plan recommendation and enrolling the consumer in a new plan?

When you discover a consumer is already enrolled in a Medicare Advantage plan, what must you do prior to making a plan recommendation and enrolling the consumer in a new plan?

• A. Compare with the consumer any plan I recommend to their current MA plan, including benefits, costs, network, and drug coverage
• B. Only present the new plan's benefits
• C. Enroll them in the new plan immediately without comparison
• D. Tell them to stay with their current plan

Answer: (A)

When you’re working with a consumer who already has a Medicare Advantage plan, the essential step is to perform a thorough, apples-to-apples comparison between the current plan and any plan you would propose before making a recommendation or enrolling them in a new plan. This ensures you’re acting in the consumer’s best interest and meeting ethical and compliance standards for objective guidance. Why this matters: Medicare Advantage plans can differ widely in what they cover and how much they cost. You need to look at the full picture of each plan, including benefits and out-of-pocket costs, how much the premium and deductibles are, what the plan’s annual out-of-pocket maximum would be, and how the network and formulary compare to the consumer’s needs. A key part of this is drug coverage: check whether the medications the consumer takes are on the proposed plan’s formulary, what the copays or coinsurance would be, and whether any prior authorizations or step therapy requirements would apply. You also want to verify provider access—whether the consumer’s current doctors, hospitals, and preferred pharmacies are in-network under the new plan—and consider any changes in extra benefits (such as dental or vision) that matter to the consumer. The process should be documented and shared with the consumer in clear terms, including a side-by-side comparison, so they can see how the new plan would affect their care and costs. Obtain informed consent to enroll after presenting the comparison, and ensure you’re operating within appropriate enrollment periods and marketing/suitability standards. This approach safeguards the consumer from unexpected changes in coverage and aligns the recommendation with their health needs and financial interests.

When you’re working with a consumer who already has a Medicare Advantage plan, the essential step is to perform a thorough, apples-to-apples comparison between the current plan and any plan you would propose before making a recommendation or enrolling them in a new plan. This ensures you’re acting in the consumer’s best interest and meeting ethical and compliance standards for objective guidance.

Why this matters: Medicare Advantage plans can differ widely in what they cover and how much they cost. You need to look at the full picture of each plan, including benefits and out-of-pocket costs, how much the premium and deductibles are, what the plan’s annual out-of-pocket maximum would be, and how the network and formulary compare to the consumer’s needs. A key part of this is drug coverage: check whether the medications the consumer takes are on the proposed plan’s formulary, what the copays or coinsurance would be, and whether any prior authorizations or step therapy requirements would apply. You also want to verify provider access—whether the consumer’s current doctors, hospitals, and preferred pharmacies are in-network under the new plan—and consider any changes in extra benefits (such as dental or vision) that matter to the consumer.

The process should be documented and shared with the consumer in clear terms, including a side-by-side comparison, so they can see how the new plan would affect their care and costs. Obtain informed consent to enroll after presenting the comparison, and ensure you’re operating within appropriate enrollment periods and marketing/suitability standards. This approach safeguards the consumer from unexpected changes in coverage and aligns the recommendation with their health needs and financial interests.