As Open Enrollment approaches, it’s time to begin preparing your pharmacy by ensuring you have the tools needed to deliver effective support for eligible patients. As the nation’s most accessible care provider, you are uniquely positioned to educate Medicare and Medicare-eligible patients about their options, and to help customers find a plan that not only fits their health and financial needs but one that also ensures that they continue doing business at their favorite pharmacy – yours!
PrescribeWellness is here to help – with an integrated Medicare Plan Review solution, available within the Patient Engagement Center, pharmacists have the ability to find win-win opportunities for their patients and pharmacy. First, to assist you in your patient consultations, let’s take a quick look at two of the main Medicare buckets that patients are likely to encounter – Original Medicare, and Medicare Advantage.
Original Medicare is government-funded insurance and consists of Part A and Part B – hospital and medical coverage, respectively. Part A and Part B both carry deductibles, coinsurance, and/or copayments for most services. With Original Medicare, patients can enroll in Part D, a stand-alone drug plan. The majority of patients who receive Social Security benefits, or who qualify by disability, are automatically enrolled in Original Medicare upon turning 65 – think of it as the default setting.
Also known as Part C, Medicare Advantage is private health insurance offered by plans that contract with Medicare. A combination of hospital, medical, and drug coverage, Medicare Advantage provides an alternative to Original Medicare by offering Part A, Part B, and Part D all rolled into one plan. When enrolling, patients should consider the following:
- Patients must have Medicare Part A and Part B
- Patients must still pay their Medicare Part B premium
- Patients are limited to the plan’s service area
Because Medicare Advantage combines hospital costs, doctor visits, dental coverage, and even gym memberships into one convenient plan, this type of coverage can be a great fit for patients who are looking to save money and gain convenience.
Pros & Cons of each Plan
Now that we have covered the options available to patients, let’s take a look at the pros and cons of each type of coverage:
|Original Medicare||Medicare Advantage|
|Pros||Patients can see any doctor or go to any hospital contracted with Medicare No prior approval or referral needed to see a specialist or have a procedureLow or no copays for medical care||Copays for doctor visits, hospitalization, and utilization of other medical servicesCap on out-of-pocket cost for hospital and medical coverageMost plans offer dental, hearing and/or vision coverage|
|Cons||Expensive medical care without a Medigap policy There is no out-of-pocket maximum spending for covered medical benefits Doesn’t cover vision, dental, or hearing – patient must sign up for supplemental coverage||Initial enrollment process may be complexLimited doctor and hospital networksReferral may be needed to see a specialist|
In short, Original Medicare may cost more, but offers more flexibility for specialized care. Conversely, Medicare Advantage can offer more supplemental coverage (dental, hearing, and/or vision), but availability may be limited depending on the patient’s service area.
Do you have the necessary solutions and workflow in place to successfully identify what plan works best for your patients? We’re here to help.
Medicare Plan Reviews through PrescribeWellness
The PrescribeWellness solution enables community pharmacists to deliver proactive and effective consultations with their patients, focused on reviewing available Medicare Part D and Medicare Advantage plans.
Through simple, dashboard comparisons of plan quality, out-of-pocket costs, and other valuable information, Medicare Plan Reviews, available within the PrescribeWellness software, create opportunities for engagement between pharmacist and patient, while also ensuring the patient is enrolled in the plan that best meets their needs. Enhanced support for Medicare Advantage plans (including medications, physicians, and additional services) and documentation of completed plan reviews, presents an all-in-one solution for pharmacists who are looking to better engage and support their patient network.
Ready to optimize your workflow? Learn more about how PrescribeWellness can support the implementation and sustainment of a successful Medicare Plan Review program – leave your information below!
We look forward to hearing from you.