Medicare Planfinder- Prescription Drug Plans & Medicare Advantage Plans.

Transcription

1 Medicare Planfinder- Prescription Drug Plans & Medicare Advantage Plans 1

2 Who We Are: Leadership AgeOptions AAA for suburban Cook County Health & Disability Advocates Policy and advocacy group Progress Center for Independent Living Cross-disability, non-residential suburban Cook County 2

3 MMW work is supported by grants from: The Chicago Community Trust Michael Reese Health Trust The Retirement Research Foundation 3

4 What We Do Gather and create practical, accessible information and materials Educate Medicare consumers, service providers and policymakers Problem solving individual and systemic Provide training and technical support for professionals and volunteers Advocate for consumer focused laws and policies Target underserved groups 4

5 What we will cover today Comparing Medicare Part D plans Comparing Medicare Advantage Plans Plan Comparison for Individuals with Extra Help 5

6 Click on Find health & drug plans 6

7 Plan Finder step-by-step demo video 7

8 Enter the client s information in either the General Search or Personalized Search. It is recommended you do a personal search if you have the client s information. 8

9 When completing a General Search, you must answer the fields listed in Step 1. 9

10 If doing a Personalized Search, the beneficiary s Part D coverage and Extra Help status (if he/she qualifies) will appear under My Current Profile. If doing a General Search, the information that appears under My Current Profile will depend on how you answer the questions in Step 1 10

11 Enter the client s prescription(s) 11

12 A pop-up box will appear. Select the dosage and enter quantity 12

13 When entering a brand name drug, a pop-up box will appear letting you know a generic is available for the drug you selected 13

14 You can print out a drug list and add to a client s file 14

15 Must select a pharmacy to proceed and can expand the mileage for a wider selection. You may also select more than one pharmacy. The plan finder will display drugs costs for the pharmacies you select. 15

16 Select the type of Part D plans you want to compare: stand-alone and/or Medicare Advantage (Medicare Health Plans) 16

17 You must select Special Needs Plans from the toolbar on the side to have them included in your plan results they do not automatically appear in the results 17

18 Comparing Stand-alone- Prescription Drug Plans (PDP) 18

19 Original Medicare will always appear in the Plan Results page. This is an estimate of costs for a beneficiary with only Part A and B coverage. You can overlook look this and proceed down the page to compare and view plans. 19

20 Select the plans you would like to view on the Your Plan Results page. You can compare up to 3 plans at a time by checking the boxes next to the plan names. Then click on Compare Plans The plans appear according to lowest estimated annual retail drug cost but you can sort by other categories like Plan Name 20

21 You may also plan results or a plan analysis 21

22 Three plan comparison. You can also click on the plan name (in blue) to see additional information including pharmacy information Medicare Therapy Management Programs 22

23 Single plan view. You can view drug costs. This page will let you know if the beneficiary will enter the donut hole and what the estimated monthly costs will be at selected pharmacies including mail order (if mail order if offered by the plan). Scroll down to view more. 23

24 Drug Benefit Summary will list the tier levels for a plan and 24 the co-pay amount is for each tier This bar chart lists the monthly costs through out the year and includes the premium, any deductible amount, co-pays and donut hole costs You can also view if a drug has a restriction. Click on the Yes to view quantity limits (if Yes appears)

25 Lists specific Quantity Limits for a drug if a Yes appears under Restrictions 25

26 Drug Benefit Summary Displays cost sharing for each tier level Includes retail 30/60 day supplies options and costs Costs for preferred and network pharmacies. Preferred pharmacies tend to offer lower costs 26

27 Click on the network pharmacies in your zip code link to view a list of network and preferred pharmacies in that zip code. Preferred pharmacies, if offered by the plan, will often have lower co-pays than network pharmacies 27

28 All listed pharmacies are in network but cost savings are usually more if the pharmacy is listed as preferred. Remember to expand the number of miles for a wider selection of preferred pharmacies 28

29 Three plan comparison. You can also click on the plan name (in blue) to see additional information including pharmacy information View star ratings for a plan by clicking on the Star Ratings tab 29

30 Plans with low ratings are identified with a symbol 30

31 Comparing Medicare Advantage Plans (Medicare Health plans) 31

32 To compare Medicare Advantage (MA) plans, select Medicare Health Plans in Step 4 32

33 Comparing drug coverage under MA plans will be the same as comparing drug coveragestand-alone plans. However, when comparing MA plans, it is very important to review the out of pocket costs for health benefits such as co-pays for each service. You should also work with the beneficiary to make certain his providers are in the plan s network. Provider information will not appear on the plan finder and you should contact the plan directly. Click on the plan name for plan specifics 33

34 Click on the Health Plan Benefits tab on top to find out how much a plan charges for each service. You can also view maximum out of pocket costs for MA plans. This varies from plan to plan and only includes Parts A and B costs (not Part D costs). 34

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36 If a plan has a premium, you can view how much is designated for the health portion and drug portion separately. By clicking on the Overview tab. 36

37 Medication Therapy Management Programs 37

38 Medication Therapy Management (MTM) Program A patient-centric, comprehensive approach to: Improve medication use Reduce risk of adverse events Improve medication adherence 38

39 Three plan comparison. You can also click on the plan name (in blue) to see additional information including pharmacy information Click the MTM tab for more information 39

40 PlanFinder & Extra Help 40

41 Full Extra Help- My Current Profile shows Extra Help Subsidy Level 41

42 Stand-alone Part D plan with Full Extra Help Example Plan Finders shows that Full Extra Help will cover -Amount of premium up to the benchmark amount -Full cost of deductible 42

43 Partial Extra Help Example- My Current Profile shows the Extra Help Subsidy Level 43

44 Stand alone Part D plan with Partial LIS Extra Help benefit amount is calculated in prices listed for monthly premium, co-payment/co-insurance, and deductible amount and calculated in Estimated Annual Drug Costs 44

45 PlanFinder shows drug co-payments based on Extra Help subsidy level (Co-payments shown here is for a beneficiary with Full Extra Help) 45

46 Medicare Advantage Plans and Full Extra Help Example Extra Help pays for drug the portion of the premium BUT not the health portion (if the MA plan has a health portion) 46

47 Training Resources For additional training opportunities visit (YouTube videos created by Medicare that explain how to use the plan finder) Medicare training site that allows counselors to practice using the plan finder dertrainingscenarios.pdf 47

48 Make Medicare Work Coalition Website Please visit our website at to... o o Access our materials on Medicare, Medicaid, and the Affordable Care Act Sign up for our list to receive registration information for our webinars, trainings, and meetings and to receive our alerts, bulletins, and other healthcare related materials o View our Calendar of Events 48