New Medicare Drug Plan Rating Tool for Advocates and Educators
The overwhelming number of Medicare prescription drug plans makes it difficult to counsel consumers. It also makes it hard for states to identify the plans that will provide the best medications and overall value for their citizens that will work best for their Medicaid and State Prescription Assistance Programs.
AARP’s new Medicare Drug Plan Rating Tool can help state government and social organizations:
- Encourage or require dual eligibles and nursing home residents
to enroll in the plans that will provide unrestricted access to the
medications these populations need.
There is significant variation in formularies and access restrictions among the plans available to the dual eligibles and nursing home residents. Most are randomly assigned to a plan by CMS. A state can conduct outreach and encourage these groups to join the plans that will provide the medications they need. Medicaid agencies can also request CMS approval to require or automatically enroll duals eligibles in plans selected by the state. This data could also be used in conjunction with the CMS Part D plan finder to counsel beneficiaries on selecting a plan that will best meet their current and future medication needs. - Ensure that those eligible for a state prescription assistance program
(SPAP) are enrolled in the plans that provide the best access to drugs and
are the most cost-effective for the state.
SPAP programs can use the data 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 comparison data can be used to identify the plans offering the widest range of drugs with the fewest restrictions and the lowest costs. - Modify the design of an SPAP.
The comparison data may point to ways to improve the cost-effectiveness of an SPAP. For example, it may be cost-effective for an SPAP to pay a slightly higher premium in order to obtain additional benefits — a $0 deductible, gap coverage, etc. An SPAP may also want to encourage or require enrollment in plans that offer broader and less restricted formularies that will foster better health outcomes and delay or prevent the need for Medicaid.
This tool is a quick guide to some of the differences between Medicare “stand alone” drug plans—those that offer only prescription drugs. You can compare plans in your state by:
- Each plan’s premiums and deductible
- An estimated cost range for an average person with Medicare
- The number of commonly used medications the plan covers
- The number of drugs commonly used by the dual eligible and nursing home resident populations that each plan covers
- Whether you’ll pay no or a reduced premium under this plan if you qualify for Extra Help
- Whether the plan pays for drugs in the coverage gap (also known as the donut hole)
Compare plans or learn more about AARP's Rating Tool:
Note: The information used in this rating tool was obtained from Medicare on November 7, 2006. Please check with individual plans for the most current updates as plan information often changes.
Consumers: Please visit AARP’s Medicare Drug Plan Rating Tool for consumers to compare Medicare prescription drug plans in your state and learn more about your options.
AARP materials are not intended to replace materials from Medicare. The AARP rating tool should be used along with other information from Medicare. For specific information on your own drug costs in 2007 visit the Medicare prescription drug plan finder at: www.medicare.gov or call the Medicare help line at 1-800-633-4227.
