Medicare Planfinder- Prescription Drug Plans & Medicare Advantage Plans.

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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

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What we will cover today

• Comparing Medicare Part D plans

• Comparing Medicare Advantage Plans

• Plan Comparison for Individuals with Extra

Help

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Click on “Find health & drug plans”

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Plan Finder step-by-step demo video

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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.

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When completing a “General Search”, you

must answer the fields listed in Step 1.

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• 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

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Enter the client’s prescription(s)

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A pop-up box will appear. Select the

dosage and enter quantity

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When entering a brand name drug, a pop-up box will appear

letting you know a generic is available for the drug you selected

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

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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.

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

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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

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Comparing

Stand-alone-Prescription Drug Plans (PDP)

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“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.

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•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”

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You may also email plan results or a plan analysis

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Medicare Therapy Management

Programs

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

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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.

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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

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

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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

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•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

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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

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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

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Plans with low ratings are identified with a symbol

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Comparing Medicare

Advantage Plans

(Medicare Health plans)

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

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•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

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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).

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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.

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Medication Therapy Management

Programs

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Medication Therapy Management

(MTM) Program

• A patient-centric, comprehensive

approach to:

– Improve medication use

– Reduce risk of adverse events

– Improve medication adherence

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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

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PlanFinder & Extra Help

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Full Extra Help-

“My Current Profile” shows Extra Help Subsidy Level

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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

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Partial Extra Help Example-

My Current Profile shows the Extra Help Subsidy Level

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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

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PlanFinder shows drug co-payments based on Extra Help subsidy level

(Co-payments shown here is for a beneficiary with Full Extra Help)

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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

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Training Resources

• For additional training opportunities visit

https://medicare.gov/find-a-plan/questions/home.aspx

(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

http://www.ageoptions.org/documents/2013PlanFin

derTrainingScenarios.pdf

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Make Medicare Work Coalition

Website

• Please visit our website at

http://www.ageoptions.org/services-and-programs_makemedicarework.html

to...

o Access our materials on Medicare, Medicaid,

and the Affordable Care Act

o Sign up for our e-mail list to receive registration

information for our webinars, trainings, and

meetings and to receive our alerts, bulletins, and

other healthcare related materials

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