Presenter: Mary McGeary Navigating the Medicare Plan Finder for Dual Eligibles Presenter: Mary McGeary NJ State Health Insurance Assistance Program SHIP ARC of NJ Webinar November 29, 2011

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

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

6 STEP Process Enter List of Current Medications Select Pharmacy Enter Consumer Information Enter List of Current Medications Select Pharmacy Refine Search Results Compare Plans Enroll 4

Getting to the Drug Plan Finder Go to www.Medicare.gov Click “Compare Drug and Health Plans” Or www.medicare.gov/find-a-plan Or call 1-800-Medicare Customer Service Assistance for choosing a plan & enrolling available 24 hrs a day English and Spanish speaking CSRs 5

www.Medicare.gov Homepage

Plan Finder Home Page: Step 1 Tutorial

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

If General Search: answer coverage and low income questions IMPORTANT TO CLICK In Medicaid circle

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

Pop-up box to indicate dosage

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

Option to search Generic or Brand

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

Step 3: Pharmacy consumer Uses Click here to expand list of pharmacy Click here to see map

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

Step 5: Compare Your Plan Results See if pharmacy in network These costs do not apply 17

Sorting Options 18

Click on name of plan to see plan details

Look at Coverage/Costs

Bar Chart to Show if and when will reach Catastrophic Coverage Copays reduced to $0 at this stage

Important: Drug Coverage and Restrictions

Details on Quantity Limits

Understanding the Tier Footnotes Avoid plans with drugs Not on Formulary 15 Plan DOES NOT cover this drug PAAD or Medicaid will NOT pay If private pay, costs for this drug will not count towards deductibles or “out of pocket” limits Options Switch Plans to one with drug on Formulary 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 24

Understanding the Tier Footnotes Not on Formulary 4 “By law this drug is EXCLUDED from being covered under Medicare program.” If have state Medicaid some excluded drugs covered under “wraparound” (ex: barbiturates, benzodiazepines, vitamins) Show Medicaid HMO ID card to pharmacy for coverage. Options if you do not have subsidy Pay out of pocket for full cost of drug See if drug manufacturer has “Patient Assistance Program (PAP)”

Points for Low Income consumers Important Points for Low Income consumers 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 benzodiazepines or barbiturates, select prescription vitamins and certain non-prescription drugs will be covered by Medicaid or PAAD IMPORTANT: If person has SPAP (NJ PAAD, NJ Sr. Gold, , copay amounts shown on Plan Finder for covered drugs do not include state subsidies 26

For Medicare/Medicaid consumers (Duals): Look for plans that meet 3 criteria: Qualify for $0 premium with LIS (called “benchmark plans”) All of consumer’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 consumer can pay the premium difference 27

Example of Good Plan Choice $0 Premium Benchmark Plan No PA or Step Therapy All drugs on formulary 28

Example of Good Plan Choice No PA or Step Therapy All drugs on formulary “Excluded” drug covered by Medicaid HMO 29

Example of Bad Plan Choice Premium Plan- Not Benchmark Drugs not on formulary PA restriction

Comparing Plans For Non-Duals 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] 31

STEP 6 : Enroll If nursing home resident, LIS or Dual can enroll or switch plans each month Will be AUTOMATICALLY disenrolled from current plan when enroll in new plan For Non-duals, enrollments limited to Medicare Enrollment Periods New to Medicare (IEP) Annual Enrollment Period (AEP) Special Enrollment Periods (SEP) 32

How to Enroll By Phone By Internet IMPORTANT: 1 (800) Medicare Call Plan Directly By Internet www.medicare.gov Plan’s website IMPORTANT: Get enrollment confirmation Advise not to pay premium by automatic deduction from Social Security check 33

Additional Tools If need to change the drug list To increase print size on screen If need to change the drug list 34

Or contact your local SHIP QUESTIONS? Submit your questions by email to mary.mcgeary@doh.state.nj.us Or contact your local SHIP 35