Conducting a Medicare Plan Review

Medicare Plan Finder helps the pharmacy identify Medicare plans that align with a patient's prescription needs and financial priorities. Review available Medicare plans, compare estimated costs, evaluate formulary coverage, and connect patients with enrollment resources through Healthpilot.

Overview

After selecting a patient from the Medicare Eligible Patients list, open the patient profile and navigate to Medicare Plan Finder from the left navigation menu.

Choose a Review Option

After opening Medicare Plan Finder, you can:

• Refer the patient to Healthpilot for enrollment assistance.
• Conduct a plan comparison directly within Medicare Plan Finder

Option 1: Refer the Patient to Healthpilot

Patients can be referred through:

• Text invitation
• Email invitation
• Printed invitation

Users may also select Find a Plan with Your Patient to access the Healthpilot experience with the patient. Healthpilot provides plan comparison and enrollment support directly to the patient.

Once redirected to Healthpilot, patients can:

• Review Medicare plan options available in their area.
• Compare plan costs, coverage, and benefits.
• Evaluate prescription drug coverage.
• Complete Medicare enrollment directly through the Healthpilot platform.

Healthpilot's enrollment experience is patient-facing and designed to guide patients through the plan selection, enrollment process and provide support to patients, if needed.

Option 2: Compare Medicare Plans

Select Plan Comparison to review Medicare plans available to the patient. By default, Medicare Advantage plans are displayed, and users can switch between supported plan types as needed.

Supported plan types include:

• Prescription Drug Plans (PDP)
• Medicare Advantage Prescription Drug Plans (MAPD)
• Medicare Advantage Special Needs Plans (MA SNP)

Review Plan Details

Plan details include:

• Plan name and carrier
• CMS Star Rating
• Pharmacy network status
• Drug formulary coverage
• Monthly premium
• Annual deductible
• Estimated monthly prescription costs
• Estimated annual patient costs
• Plan graphs display patient's prescription expenses:
  • Dark Blue Bars- Patient's estimated monthly out-of-pocket costs, such as deductibles and premium costs.
  • Light Blue Bars- Patient's estimated medication costs for each month

Review Medication Coverage 

Expand a plan to review medication-specific details, including:

• Formulary status
• Copay information
• Prior authorization requirements
• Quantity limits
• Step therapy requirements
• Estimated medication costs
• Ability to include/ exclude medications from plan comparison

Medication Playground

The Medication Playground allows users to add medications and evaluate how potential therapy changes may affect plan costs and coverage. This can be useful when discussing future medications or alternative therapies with a patient. Enter a new medication in Add Medication field under monthly breakdown graph to evaluate how the medication impacts plan costs. 

Filter Plan Results

Use filters to narrow plan results based on:

• Plan Details

  • Star Rating

  • Monthly Premium

  • Annual Deductible

  • Estimated Drug Costs

  • Network Status

• Drug Coverage

  • Drugs on Formulary

  • Quantity Limits

  • Prior Authorization

  • Step Therapy

• Special Needs

  • Extra Help (LIS) considerations

Decline a Plan Review

If a patient chooses not to participate, select Decline Plan Review. The patient will be moved to the Declined tab within the Medicare Eligible Patients list 

Compare Plans Side- by Side

Select up to three plans and choose Compare to evaluate plan information side-by-side. This view helps identify differences in:

• Coverage
• Network status
• Premiums
• Deductibles
• Medication Costs
• CMS Star Ratings