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State Health Insurance Assistance Program

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Presentation on theme: "State Health Insurance Assistance Program"— Presentation transcript:

1 State Health Insurance Assistance Program
Navigating the Medicare Plan Finder New Jersey State Health Insurance Assistance Program November

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 Beneficiary’s 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 Enter List of Current Medications Select Pharmacy
Enter Beneficiary Information Enter List of Current Medications Select Pharmacy Refine Search Results Compare Plans Enroll 4

5 Getting to the Drug Plan Finder
Go to Click “Compare Drug and Health Plans” Or Or call Medicare Customer Service Assistance for choosing a plan & enrolling available 24 hrs a day English and Spanish speaking CSRs 5

6 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” [bulleted text from previous slides showing this screen] 8

9 If General Search: Important to answer questions about low income assistance
Can leave blank Click here if Dual

10 Step 2: Enter Your Drugs Can type in drug name 10
Or search drug by first letter 10

Pop-up box to indicate dosage NEW QUESTION ON TYPE OF PHARMACY

12 Write down ID for future searches
Info to Notice: Write down ID for future searches 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

19 Sorting Options 19

20 For Details on a Plan: 1. Click plan name 2
For Details on a Plan: Click plan name 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 [bulleted text from previous slide showing this screen] 21

22 SilverScript Choice (PDP)
COST DETAILS SilverScript Choice (PDP)

23 Bar Chart to Show When Changes in Coverage Levels Occur

24 Important: Drug Coverage Details

25 Details on Quantity Limits

26 Understanding the Tier Footnotes
Avoid plans with drugs Not on Formulary 15 Plan DOES NOT cover this drug PAAD/Senior Gold or Medicaid will NOT pay If private pay, costs for this drug will not count towards deductibles or “out of pocket” limits Options Switch to generic or similar drug covered by the plan with doctor’s approval (example: switch from Lipitor to simvastatin) Ask plan for “exception” to cover the drug for you because alternative will not work (need doctors input) Pay full price for the drug out of pocket Switch Plans to one with drug on Formulary allowed enrollment period 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 Points for Low Income Clients
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 plan’s 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 client’s meds are on plan’s 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 Plan’s website to view Plan’s “Summary of Benefits”

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 By Internet IMPORTANT:
1 (800) Medicare Call Plan Directly By Internet Plan’s 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 If need to edit the drug list
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 Medicare Or NJ SHIP Hotline 45

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