Medicare Planfinder-
Prescription Drug Plans &
Medicare Advantage Plans
www.Medicare.gov
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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
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MMW work is supported by grants
from:
• The Chicago Community Trust
• Michael Reese Health Trust
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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
What we will cover today
• Comparing Medicare Part D plans
• Comparing Medicare Advantage Plans
• Plan Comparison for Individuals with Extra
Help
Click on “Find health & drug plans”
Plan Finder step-by-step demo video
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.
When completing a “General Search”, you
must answer the fields listed in Step 1.
• 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
Enter the client’s prescription(s)
A pop-up box will appear. Select the
dosage and enter quantity
When entering a brand name drug, a pop-up box will appear
letting you know a generic is available for the drug you selected
You can print out a drug list and add to a client’s file
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.
Select the type of Part D plans you want to compare: stand-alone and/or Medicare Advantage (Medicare Health Plans)
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
Comparing
Stand-alone-Prescription Drug Plans (PDP)
“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.
•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”
You may also email plan results or a plan analysis
Medicare Therapy Management
Programs
Three plan comparison. You can also click on the plan name (in blue) to see additional information including pharmacy information
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.
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)
““Drug Benefit Summary” will list the tier levels for a plan and the co-pay amount is for each tier
Lists specific Quantity Limits for a drug if a “Yes” appears under “Restrictions”
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
•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
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
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
Plans with low ratings are identified with a symbol
Comparing Medicare
Advantage Plans
(Medicare Health plans)
To compare Medicare Advantage (MA) plans, select “Medicare Health Plans” in Step 4
•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
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).
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.
Medication Therapy Management
Programs
Medication Therapy Management
(MTM) Program
• A patient-centric, comprehensive
approach to:
– Improve medication use
– Reduce risk of adverse events
– Improve medication adherence
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
PlanFinder & Extra Help
Full Extra Help-
“My Current Profile” shows Extra Help Subsidy Level
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
Partial Extra Help Example-
My Current Profile shows the Extra Help Subsidy Level
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
Stand alone Part D plan with Partial LIS
PlanFinder shows drug co-payments based on Extra Help subsidy level
(Co-payments shown here is for a beneficiary with Full Extra Help)
Extra Help pays for drug the portion of the premium BUT not the health portion (if the MA plan has a health portion)
Medicare Advantage Plans and Full Extra Help Example
