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. www.Medicare.gov Homepage

7. Plan Finder Home Page: Step 1
Tutorial

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

11. NEW QUESTION ON TYPE OF PHARMACY
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 Results18

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
Yes

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”38

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