1. 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

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 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

4. 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

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

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

11. Pop-up box to indicate dosage

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

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

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

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

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

18. Sorting Options 18

19. Click on name of plan to see plan details

20. Look at Coverage/Costs

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

22. Important: Drug Coverage and Restrictions

23. Details on Quantity Limits

24. 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

25. 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)”

26. 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

27. 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

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

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

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

31. 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

32. 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

33. 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 33

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

35. Or contact your local SHIP
QUESTIONS?
Submit your questions
by to
Or contact your local SHIP 35