Medicare Prescription Drug Plan Finder - PowerPoint PPT Presentation

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Medicare Prescription Drug Plan Finder

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Navigating the Medicare Plan Finder New Jersey State Health Insurance Assistance Program November 2 2012 * * Example of Good Plan Choice * All drugs on formulary No ... – PowerPoint PPT presentation

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Title: Medicare Prescription Drug Plan Finder


1
Navigating the Medicare Plan Finder
New Jersey State Health Insurance Assistance
Program November 2 2012
2
What is the Medicare Plan Finder?
  • Internet Tool on official Medicare web site
  • Helps people learn about drug coverage and
  • Review current Medicare enrollment
  • Compare Part D plans Medicare Advantage Health
    Plans (HMOs/PPOs)
  • Identify which plans cover your prescriptions at
    most affordable cost
  • Enroll in a Part D or Medicare Advantage plan


2
3
Getting Started What You Will Need
  • Beneficiarys zip code
  • List of beneficiary's prescription drugs
  • strength and quantity
  • if can take generics
  • Pharmacy beneficiary uses
  • Other Helpful Information
  • Medicare Card
  • Other Health Insurance cards
  • Subsidy eligibility
  • Medicaid, LIS, PAAD


3
4
6 STEP Process
  1. Enter Beneficiary Information
  2. Enter List of Current Medications
  3. Select Pharmacy
  4. Refine Search Results
  5. Compare Plans
  6. Enroll

4
5
Getting to the Drug Plan Finder
  • Go to www.Medicare.gov
  • Click Compare Drug and Health Plans
  • Or www.medicare.gov/find-a-plan
  • Or call 1-800-Medicare
  • Customer Service Assistance for choosing a plan
    enrolling
  • available 24 hrs a day
  • English and Spanish speaking CSRs

5
6
www.Medicare.gov Homepage
7
Plan Finder Home Page Step 1
8
Select a Search Option
  • To do General Search
  • Type in Zip Code only
  • If Choose Personalized Search
  • Requires Medicare card, DOB, ZIP Code on
    record
  • Helps confirm current plan enrollment and low
    income status
  • Click box on bottom Find Plans

8
9
If General Search Important to answer questions
about low income assistance
10
Step 2 Enter Your Drugs
Can type in drug name
Or search drug by first letter
10
11
Pop-up box to indicate dosage
NEW QUESTION ON TYPE OF PHARMACY
12
Info to Notice
Click here when drug list complete
13
Option to search Generic or Brand- Important to
check with client to see which version they take
14
Pop-up will warn when have added both a brand
drug its generic equivalent to the list
15
Step 3 Pharmacy Client Uses
Click here to expand list of pharmacies
Click here to see map
16
Step 4 Refine Results Looking at Stand Alone
Plans (PDPs) or Health Plans with drug coverage
(MAPDs) ?
17
Icons
17
18
Step 5 Compare Your Plan Results
18
19
Sorting Options
19
20
For Details on a Plan 1.
Click plan name 2.
Then click tab
Drug Costs Coverage
21
Compare Plan Details
  • Look at 5 Factors
  • Costs Estimated Annual Cost Most Important
  • Lowest Premium May NOT be lowest cost plan
  • Coverage Is drug on Plan Formulary?
  • Drug Restrictions
  • Pharmacy Network
  • Coordination with other benefits

21
22
SilverScript Choice (PDP)
COST DETAILS
23
Bar Chart to Show When Changes in Coverage
Levels Occur
24
Important Drug Coverage Details
Yes
25
Details on Quantity Limits
26
Understanding the Tier Footnotes
26
27
Understanding the Tier Footnotes
  • Not on Formulary 4
  • By law this drug is EXCLUDED from being
    covered under Medicare program.
  • Options
  • Pay out of pocket for full cost of drug
  • See if drug manufacturer has Patient Assistance
    Program (PAP)
  • For other excluded categories may need Enhanced
    Plan for coverage
  • If have state Medicaid some excluded drugs
    covered under wraparound (ex vitamins)

28
View Drug Benefit Summary button to see if plan
has preferred pharmacy prices
Silverscript Choice
29
View Pharmacy Network
30
Tool to Lower Costs
31
Can Compare up to 3 plans side-by-side
32
Important Points for Low Income Clients
  • Premium and Other Costs
  • If Medicare/Medicaid has been noted amounts will
    reflect Extra Help/LIS subsidy
  • If Premium 0 it is benchmark plan
  • If a premium amount is shown this is difference
    between plans basic premium and LIS subsidy
  • Disregard costs for Excluded drugs" (footnote
    4), that are select prescription vitamins and
    certain non-prescription drugs will be covered by
    Medicaid

IMPORTANT If person has NJ PAAD or NJ Sr. Gold,
copay amounts shown on Plan Finder for covered
drugs do not include state subsidies
32
33
For Medicare/Medicaid Clients (Duals) Look for
plans that meet 3 criteria
  • Qualify for 0 premium with LIS (called
    benchmark plans)
  • All of clients meds are on plans formulary
    (unless in excluded class)
  • No or minimum restrictions on meds
  • NOTE If cannot find 0 premium plan to meet all
    above, can look at non-benchmark plans and ask if
    client can pay the premium difference

33
34
Example of Good Plan Choice
0 Premium Benchmark Plan
No PA or Step Therapy
All drugs on formulary
34
35
Example of Bad Plan Choice
CIGNA Medicare Rx
Premium Plan- Not Benchmark
Drugs not on formulary
PA restriction
36
Comparing Plans for those with LIS
37
Comparing Medicare Health Plans (MAs) Health
Benefits Tab
38
Link to MA Plans website to view Plans Summary
of Benefits
38
39
Plan Star Ratings
  • Rating of One to Five Stars
  • Based on Medicare Audits and Member Surveys
  • Look at Customer Satisfaction, Complaints,
    Experiences, Pricing
  • Ratings posted annually by mid October
  • New SEP started 2012 Can switch to Five Star
    Plan once during the year (no Five Star Plans in
    NJ in 2012)

40
STEP 6 Enroll
  • Limited to Medicare Enrollment Periods
  • New to Medicare (IEP)
  • Annual Enrollment Period (AEP)
  • Special Enrollment Periods (SEP)
  • If SNF resident, LIS or Dual can enroll or switch
    plans each month
  • Will be AUTOMATICALLY disenrolled from current
    plan when enroll in new plan

40
41
How to Enroll
  • By Phone
  • 1 (800) Medicare
  • Call Plan Directly
  • By Internet
  • www.medicare.gov
  • Plans website
  • IMPORTANT
  • Get enrollment confirmation
  • Advise not to pay premium by automatic deduction
    from Social Security check

41
42
PRINTING YOUR PLAN CHOICES Use Print Plan
Report button and select information to print
43
Additional Tools
To increase print size on screen
If need to edit the drug list
43
44
Click here on watermark
Enter NJ and your SHIP office phone number below
45
QUESTIONS?
  • Call 1-800-Medicare
  • Or NJ SHIP Hotline
  • 1-800-792-8820

45
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