Medicare Café - Group Coverage Prospects

Running into prospects with group coverage? 

Keep tabs on them!

Almost 30% of Medicare beneficiaries have employer-sponsored health insurance.

For many agents, this is a stopping point. They thank them for their time and move on to the next prospect. In some, if not many cases, this can be the proper move. Either their employer-sponsored coverage has greater benefits than the plan you are offering, or the beneficiary has the “I earned this coverage so I am going to use it” mentality, which can be challenging to overcome even if the plan you present has greater benefits.

Medicare Group Coverage Prospects

If your prospect decides to keep their employer-sponsored health insurance plan into Medicare, then it is VITAL that you keep tabs on the plan. For many companies, retiree benefits are a huge cost they may be looking to reduce or even avoid. If this happens, you need to be aware of it and react to help those affected by the changes. 


There was a large automotive plant several years ago that decided that any non-union retiree will no longer receive their health insurance plans but rather an allowance to go purchase their own individual plans from the market. This left a lot of people scrambling to acquire coverage.

If you keep tabs on which prospects in your CRM have what retiree coverage, you could easily pull a list from your CRM and start calling them asking if you can help them navigate their options. Not only would the prospect be thankful that you were there to help them, but also impressed that you kept tabs on them and were there at their time of need.

TIP:  Make a unique field in your CRM for employer-based coverage.

Here are some other tips to keep in mind when you come across group coverage:

  • Find out when the plan’s enrollment times occur.
  • Does the plan work with a Medicare Advantage plan?
    • There are some plans that will coordinate benefits with a Medicare Advantage plan. 
    • This may work as the MA plan pays first, the employer-sponsored plan pays second, and the client has no out-of-pocket costs.
  • Does the plan allow re-enrollment?
    • With some plans, once the member leaves the plan, they are no longer able to re-enroll during the next open enrollment.
  • Keep the communication open! 
    • Put them in your newsletter distribution list and offer to follow up at least once a year to check in (usually around their open enrollment).

Remember, in some employer-sponsored situations, a “no, I don’t need coverage I am going to stick with my current plan,” can change very quickly and the agent who watches the market and can react will be the one with the new client!

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