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PEAK · Plan Selection & Sales Strategies

Before You Say “No Better Plan…”

Work through every section before you disposition a call as no appropriate plan change.

Before you say "No Better Plan" — work through this list. It's the same eight-part review from the lessons above, in one place.

Discovery

Identified the client's top 2–3 needs
Understand why they took the call today
Asked what they'd want to improve about their current coverage

Coverage

Reviewed current plan
Reviewed previous plan history
Checked for a future-effective plan
Understand why coverage changed, if it did

Eligibility

Confirmed Medicare eligibility
Checked Medicaid status
Checked LIS / Extra Help status
Considered chronic-condition eligibility, where applicable
Confirmed a valid enrollment period or SEP

Network

Compared HMO vs. PPO for this client's situation
Confirmed PCP participation
Confirmed specialist participation
Confirmed hospital participation
Asked about provider preferences directly

Cost

Compared premium
Compared medical deductible
Compared maximum out-of-pocket (MOOP)
Compared PCP copay
Compared specialist copay
Compared hospital cost-share
Compared outpatient cost-share
Compared cost for other frequently used services

Prescriptions

Verified all current medications
Checked the formulary
Checked tier placement
Checked the drug deductible
Checked monthly cost
Checked preferred pharmacy
Checked for restrictions (prior auth, step therapy, quantity limits)

Benefits

Compared dental
Compared vision
Compared hearing
Compared OTC / eligible spending benefits
Compared transportation
Compared Part B premium reduction
Compared any other relevant supplemental benefits

Decision

Identified the strongest legitimate reason this plan fits
Can explain that reason as a real-life scenario
Confirmed the client agrees the difference matters to them
Explained the important tradeoffs honestly
Confident this is in the beneficiary's best interest

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