Once a meeting has been consented by a client via the established CMS (Centers for Medicare and Medicaid) guidelines, an HHSC consultant will begin with a basic needs assessment. The assessment will include general questions for the purpose of understanding the client’s needs. The questions are NOT to include PHI (Private Health Information) other than those required and allowed by a plan, such as ESRD (End Stage Renal Disease) to determine eligibility. During the needs assessment process, eligibility for extra help programs may be reviewed if the client wishes. Extra help programs can include:

• LIS (low Income Subsidy) programs for Part D
• State Pharmaceutical Assistant Program
• MSP (Medicare Savings Plan) for Medicare part B reimbursement.

Here’s what will be discussed during the consultation:

• A basic review of the workings of traditional Medicare will follow the needs assessment before moving on to any specific product. This is done to make sure the client fully understands the nature of the program being reviewed.
• Enrollment periods will be explained.
• The workings of Prescription Part D will be explained.
• If reviewing a plan with a network such as an HMO (Health Maintenance Organization), or PPO (Preferred Provider Organization) with in-network requirements, all the clients current Doctors will be reviewed to assure participation and no interruption in service.
• The Clients list of prescription drugs will be checked and cross referenced with a plan formulary (list) to assure coverage.
• The summary of benefits for any plan being evaluated will be reviewed in its entirety to assure proper understanding.
• Any questions will be answered before concluding the consultation.
• An application will be accepted upon clients request to enroll in a plan (assuming eligibility permits).

Please note that a successful consultation will include the above steps. This example however is a general view of what a client can expect, and not meant to be an exact representation. A consultation will take approximately one hour.

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