Aetna | Compliance Connection

April 3, 2023

For Aetna Medicare Distribution Partners

In this issue:

  • Your client’s questions are keys to a successful enrollment
  • Members in certain non-DSNP plans are surprised when they don’t automatically qualify for the plan’s Extra Benefit Card on their effective date

Your client’s questions are keys to a successful enrollment

Clients who are comfortable asking questions prior to enrollment will be confident in their health plan decision. They will be more likely to stick with their plan choice and less likely to disenroll or file a complaint with Medicare.

How can you help your clients feel comfortable asking questions?

  1. Provide thorough but clear information: You already have the scripting and tools to do this.
  2. Encourage them to ask questions: Here are some questions that can encourage a two-way conversation: “I know this is a lot of information. Do you have any questions I can answer?” Or “Is there anything that you need me to review again?” Or “What else would you like to know?”
  3. Follow these do’s and don’ts:

    1. Maintain a receptive, welcoming tone in your voice. Remember, it’s not just what you say but how you say it.
    2. Respond positively when a client asks you a question.
    3. Use statements such as “That’s a good question,” or “I would be happy to explain that/check that for you.”Don’t:
    4. Rush your client through plan options. This can be stressful for them.
    5. Make statements that could discourage your client from asking questions. For example, don’t say “We don’t have much time” or “Ask all your questions now because if you ask them later, I will have to replay the disclaimer.”

Members in certain non-DSNP plans are surprised when they don’t automatically qualify for the plan’s Extra Benefit Card on their effective date

Here’s how you can help clients avoid surprises

  1. Become familiar with the Aetna plans that offer the Extra Benefits Card.
  2. For plans that offer the Extra Benefit Card, always check the plan’s Summary of Benefits for eligibility requirements. If a plan has eligibility requirements for this benefit, it will be listed in the Summary of Benefits right above the Extra Benefits Card description.
    1. Dual Eligible Special Needs Plans (D-SNP): These plans do not have eligibility requirements so the benefit is available to all members.
    2. Value-Based Insurance Design (VBID) requirements: For plans with VBID eligibility requirements, only members who receive the Low Income Subsidy (LIS), also known as “Extra Help,” are eligible.
    3. Special Supplemental Benefits for the Chronically Ill (SSBCI) requirements: For plans with SSBCI requirements, only members with specific medical conditions who meet certain criteria are eligible. Aetna determines eligibility.
  3. For plans that include SSBCI eligibility for the Extra Benefits Card, set the right expectation with your clients:
    1. Explain that Aetna will determine whether a member is eligible.
    2. You can refer to the qualifying chronic conditions listed in the Evidence of Coverage. But you may not inform the enrollee that they qualify for the benefit. Only Aetna can make that determination.
    3. Your client will need to call the Aetna Member Service number on their ID card to begin the determination process, once they become effective with the plan.
  4. Set the right expectations regarding timing:
    1. For any member who meets eligibility requirements, Extra Benefits Card benefits will not be available until the member is set up in our vendor’s system and they receive an Extra Benefits Card.


For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881


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