How to Present Medicare Advantage Plans to Clients the Right Way
In short: Present Medicare Advantage as an all-in-one alternative to Original Medicare: it covers everything Parts A and B cover, usually includes Part D, often adds dental, vision and hearing, and limits yearly out-of-pocket costs. Then test every plan against the client’s doctors, prescriptions and budget. A clear, needs-based presentation builds trust, prevents rapid disenrollment and keeps you compliant.
Medicare Advantage keeps growing. In 2026, about 35.2 million people, or 55% of eligible Medicare beneficiaries, are enrolled in a Medicare Advantage plan, according to KFF. Special needs plans now make up 23% of Medicare Advantage enrollment nationwide, and about 30% or more in South Carolina, Georgia and Florida.
With so many plans on the market, clients need a guide, not a pitch. Here’s how to present Medicare Advantage the right way.
How Do I Explain Medicare Advantage in Plain Language?
Use three simple points:
- It replaces how you get Parts A and B. You stay in Medicare and keep paying your Part B premium.
- It’s offered by private insurers approved by Medicare. Each plan has its own network, costs and extras.
- It has a yearly out-of-pocket limit. Once you reach it, the plan pays 100% of covered medical services for the rest of the year.
If the client still mixes up the parts, step back and use our Parts A, B, C and D framework.
What Should I Compare Between Plans?
Premiums get the attention, but they’re rarely the most important number.
| What to compare | Why it matters |
|---|---|
| Provider network | Are the client’s doctors and hospitals in network? HMO or PPO? |
| Drug coverage | Are their prescriptions on the formulary, at what tier and with what restrictions? |
| Maximum out-of-pocket | The most they could pay in a bad year |
| Copays and coinsurance | What a typical year of care will cost |
| Extra benefits | Dental, vision, hearing, fitness, OTC allowances and transportation |
| Star rating | Plan quality and a possible 5-star Special Enrollment Period |
| Prior authorization | How often the plan requires approval before care |
Walk through a “typical year” and a “bad year” for each plan. Clients understand real dollar amounts better than plan grids.
When Is a Special Needs Plan the Right Fit?
Special needs plans (SNPs) serve specific groups:
- D-SNPs for clients with both Medicare and Medicaid.
- C-SNPs for clients with certain chronic conditions, such as diabetes or heart failure.
- I-SNPs for clients living in an institution, such as a nursing home.
SNPs are a large share of Medicare Advantage enrollment across the Southeast. Learn the eligibility rules and verify Medicaid levels or qualifying conditions before you enroll anyone.
How Do I Keep My Medicare Advantage Presentation Compliant?
- Document a Scope of Appointment before discussing Medicare Advantage or Part D. See CMS’s 2027 change to the 48-hour SOA rule.
- Review the Pre-Enrollment Checklist with the client before enrolling.
- Use the required disclaimer that you don’t offer every plan in the area.
- Use only carrier-approved materials.
- Never pressure a client or promise benefits a plan doesn’t offer.
Follow CMS marketing rules and each carrier’s guidelines at every step.
How Do I Prevent Rapid Disenrollment?
A client who leaves a plan in the first few months costs you the relationship and often the commission.
- Confirm every doctor and prescription before enrolling.
- Explain prior authorization and referral rules up front.
- Set expectations on extra benefits, including any limits or allowances.
- Call after ID cards arrive and after the first doctor visit.
- Review the Annual Notice of Change with every client each fall.
How Does Lourie Agent Partners Help You Sell Medicare Advantage?
- Access to Medicare Advantage and Part D plans from many national and regional carriers, with direct appointments in your name.
- Free myLourie software that compares Medicare Advantage and Part D plans against a client’s prescriptions and handles enrollment.
- Advanced Marketing Program campaigns for turning-65, D-SNP, C-SNP and AEP prospects.
- Compliance and product training through webinars, workshops and the weekly “The Latest from Lourie” email.
- Live support during appointments, after-hours appointment help and extended hours during AEP.
If you’re weighing an FMO for Medicare Advantage, read how to select the right FMO.
Frequently Asked Questions
Yes, even with a $0 premium plan.
An HMO usually requires in-network providers and may require referrals. A PPO covers out-of-network care, usually at a higher cost.
No. Medigap only works with Original Medicare. Clients who want a Medigap plan must leave Medicare Advantage during an eligible enrollment period.
Clients with both Medicare and Medicaid who meet the plan’s Medicaid eligibility requirements and live in its service area.
Broad carrier access, direct contracting, commissions paid to you, day-one vesting, compliance training and real support during AEP.
Present Medicare Advantage With Confidence
Clear, honest comparisons keep clients enrolled and referring. Let us give you the tools and support to do it well. Get contracted with Lourie Agent Partners or call (803) 256-2067.