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1 Navigating the Medicare Plan Finder New Jersey State Health Insurance Assistance Program November 2 2012.

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Presentation on theme: "1 Navigating the Medicare Plan Finder New Jersey State Health Insurance Assistance Program November 2 2012."— Presentation transcript:

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

2 22 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

3 33 Getting Started: What You Will Need Beneficiarys zip code List of beneficiary's prescription drugs o strength and quantity o if can take generics Pharmacy beneficiary uses Other Helpful Information Medicare Card Other Health Insurance cards Subsidy eligibility o Medicaid, LIS, PAAD

4 44 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

5 55 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

6 6 Homepage

7 7 Plan Finder Home Page: Step 1 Tutorial

8 88 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

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

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

11 11 Pop-up box to indicate dosage NEW QUESTION ON TYPE OF PHARMACY

12 12 Info to Notice: Click here when drug list complete Write down ID for future searches

13 13 Option to search Generic or Brand- Important to check with client to see which version they take

14 14 Pop-up will warn when have added both a brand drug & its generic equivalent to the list

15 15 Step 3: Pharmacy Client Uses Click here to expand list of pharmacies Click here to see map

16 16 Step 4: Refine Results : Looking at Stand Alone Plans (PDPs) or Health Plans with drug coverage (MAPDs) ?

17 17 Icons 17

18 18 Step 5: Compare Your Plan Results 18

19 19 Sorting Options 19

20 20 For Details on a Plan: 1. Click plan name 2. Then click tab Drug Costs & Coverage

21 21 Compare Plan Details Look at 5 Factors: 1.Costs : Estimated Annual Cost Most Important Lowest Premium May NOT be lowest cost plan 2.Coverage – Is drug on Plan Formulary? 3.Drug Restrictions 4.Pharmacy Network 5.Coordination with other benefits

22 22 SilverScript Choice (PDP) COST DETAILS

23 23 Bar Chart to Show When Changes in Coverage Levels Occur

24 24 Important: Drug Coverage Details Yes

25 25 Details on Quantity Limits

26 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 doctors 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

27 27 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) Understanding the Tier Footnotes

28 28 View Drug Benefit Summary button to see if plan has preferred pharmacy prices Silverscript Choice

29 View Pharmacy Network 29

30 30 Tool to Lower Costs

31 31 Can Compare up to 3 plans side-by-side

32 32 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 Points for Low Income Clients IMPORTANT: If person has NJ PAAD or NJ Sr. Gold, copay amounts shown on Plan Finder for covered drugs do not include state subsidies

33 33 For Medicare/Medicaid Clients (Duals): Look for plans that meet 3 criteria: 1.Qualify for $0 premium with LIS (called benchmark plans) 2.All of clients meds are on plans formulary (unless in excluded class) 3.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

34 34 Example of Good Plan Choice 34 All drugs on formulary No PA or Step Therapy $0 Premium Benchmark Plan

35 35 Example of Bad Plan Choice Premium Plan- Not Benchmark Drugs not on formulary PA restriction CIGNA Medicare Rx

36 36 Comparing Plans for those with LIS

37 37 Comparing Medicare Health Plans (MAs): Health Benefits Tab

38 38 Link to MA Plans website to view Plans Summary of Benefits 38

39 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 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

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

42 42 PRINTING YOUR PLAN CHOICES: Use Print Plan Report button and select information to print

43 43 Additional Tools To increase print size on screen If need to edit the drug list

44 Click here on watermark Enter NJ and your SHIP office phone number below

45 45 QUESTIONS? Call Medicare Or NJ SHIP Hotline

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