More on AARP's Medicare Drug Plan Rating Tool
By: Source: AARP.org Date Posted: 2006-12-21 15:04:00-05:00
AARP's Medicare Drug Plan Rating Tool is a quick guide to some of the broad differences between Medicare "stand alone" drug plans (those that offer only prescription drugs). It is intended to complement, rather than replace, the Medicare Part D Plan Finder, Medicare's one-on-one counseling at 1-800-633-4227 and the state Senior Health Insurance Assistance Program (SHIP). Information on SHIPs is available by calling call Medicare or visiting www.shiptalk.org.
The chart below indicates the information available from the CMS Medicare Part D Plan Finder and the AARP Rating Tool:
| CMS Medicare Part D Plan Finder | AARP Medicare Drug Plan Rating Tool | |
| Premium | ||
| Deductible | ||
| Gap coverage | ||
| "Extra Help" qualified | ||
| Total cost based on individual's current drug use | ||
| Total cost for those using a low, medium and high number of drugs | ||
| Number of the top 100 drugs commonly used by Medicare beneficiaries covered by each plan | ||
| Percent of the top 25 drugs commonly used by those with both Medicare and Medicaid covered without restriction by each plan | ||
| Percent of the top 25 drugs commonly used by nursing homes residents covered without restriction by each plan |
These tools can help people who are:
- New to Medicare and want Medicare prescription drug coverage:
They can join a drug plan up to three months before and no later than three months after the month they become eligible. - Enrolling in Medicare Part D for the first time even though they have been eligible:
They can enroll in a plan between November 15 and December 31 each year. A late enrollment penalty may apply if they did not have creditable drug coverage from another source. - Currently enrolled in a Part D plan, but think they may want to change plans:
Anyone enrolled in a drug plan can choose a new plan between November 15 and December 31 each year. - Eligible for "Extra Help" from Part D:
They can enroll in a Part D plan between November 15 and December 31 while applying for Extra Help. Those currently receiving Extra Help can switch plans every month. Those who are losing Extra Help for 2007 can change plans between November 15 and December 31.
These tools can help state government and social services organizations to:
- Counsel individuals on Part D enrollment:
While Medicare's Plan Finder provides detailed information on which Part D plans best match an individual's current drugs, only a small percentage of Medicare beneficiaries use the Plan Finder. The Rating Tool allows easy comparison of Part D plans, taking into account total annual costs (premiums, deductibles, copays, coinsurance and coverage in the gap) and unrestricted formulary access. - Encourage or require dual eligibles and nursing home residents to enroll in the plans that will provide unrestricted access to the common medications:
There is significant variation in plan formularies and access restrictions, but most dual eligibles and nursing home residents are randomly assigned to a plan by CMS. A state can conduct outreach to promote plans with the best and most accessible formularies. Medicaid agencies can request CMS approval to require or automatically enroll dual eligibles in plans selected by the state. - Ensure that those eligible for a State Prescription Assistance Program (SPAP) are enrolled in the plans that provide the best access to drugs and that are the most cost-effective for the state:
SPAP programs can use the Rating Tool to develop counseling, education and outreach programs and to support a request for CMS approval for required or auto-enrollment of SPAP beneficiaries in state-designated plans. The Rating Tool can be used to identify the plans with the widest range of drugs, the fewest restrictions and the lowest total costs. - Modify the design of an SPAP:
The Rating Tool may point to ways to improve the cost-effectiveness of an SPAP. An SPAP may also want to encourage or require enrollment in plans with broader, less restricted formularies that will foster better health outcomes and delay or prevent the need for Medicaid.
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