 |
|
|
|
PDP-Compare Tutorial
This tutorial explains how to search and compare Medicare Part D plans using PDP-Compare.
:: One-Click Comparison
:: PDP-Compare Search Criteria
:: Example 1: Changes in Current Plan
:: Example 2: 2012 Plan no longer offered in 2013
:: Example 3: Change in Plan Coverage from 2012 to 2013
:: Example 4: Advanced Search - Comparing Plans from Different Companies.
:: Example 5: Advanced Search - Premium increases in California
:: Chart Key: What do all of the Chart Fields Mean?
PDP-Compare Search Criteria
Each State offers 40 or more Medicare Part D plans. Sometimes it helps to reduce the number of plans that you want to compare. This section explains the search and sort options in PDP-Compare.
The Search Criteria are divided into three areas:
- Those applying to the plan independent of the plan year
- Criteria to be used against the 2012 plans
- Criteria to be used against the 2013 plans
|
|
|
Criteria that are used independent of the plan year include:
- State - this is a required field. You must select a state.
- Plan Family - If you are only interested in certain plans, ex: AARP, then just select the family of plans from the drop-down list.
- Other Options - click the checkbox to show only those plans that will be discontinued in 2013.
- Sort Results by - Premiums, Plan name, Plan rating, Popularity (Enrollment)
|
|
|
Criteria that apply to a particular plan year must be entered in the appropriate column for the year (2012 or 2013) the search criteria include:
- Maximum Premium - Which plans under $25 in 2012 are still under $25 in 2013? - enter 25 in the 2012 column and 25 in the 2013 column (Answer: in Arizona, only 2 of the 3 plans under $25 in 2012 are still under $25 in 2013, plus a new plan under $25 has been added.
- Maximum Deductible - is used just as maximum premium is above.
- Type of Gap Coverage - is used just as maximum premium is above, except you select an option in the appropriate column 2012 or 2013 fields.
- Full Low-Income Subsidy? - Choose one of the three options: Yes, show only plans that qualify, No, I receive no or only partial extra help, or Only show Plans that DO NOT qualify for $0 Premium. This option is used if you would like to see only plans which changed their qualification status. Example: select Yes... in the 2012 column and Only show Plans that DO NOT qualify ... in the 2013 column. You will see that in Arizona, one plan no longer qualify for the LIS $0 Premium status. Switch the 2012 and 2013 criteria to see that one plan qualifies in 2013 that did not qualify in 2012.
|
:: Go to PDP-Compare
|
:: Top
|
Example 1: Changes in Current Plan
In this example our New York beneficiary wants to see what changes they can expect in their current plan. We have selected New York as our state. Note that State is the only field that must be entered prior to a search. Since the beneficiary is only interested in Humana Plans, we can narrow down the comparison by selecting Humana in the Plan Family field. We have left the Full Low-Income Subsidy (LIS) field set to No... so that we will see plans which qualify and also those that do not qualify. Then click on Search
The comparison of the three Humana plans (Walmart-Preferred, Enhanced, and Complete) is shown and is shown for both 2012 and 2013. Our beneficiary can quickly see that the 2012 Humana Walmart-Preferred plan which qualified for the LIS $0 premium last year still qualifies in 2013. They can also see that the 2013 Enhanced plan is less expensive than its 2012 counterpart. Also, they can see that in 2012, 21,507 people enrolled in the Walmart-Preferred plan in New York and only 30,825 enrolled in the Enhanced plan. Note that the CMS Quality Ratings are the same for all three Humana plans. The CMS Ratings are reported by company, not plan.
|
:: Go to PDP-Compare to see this example: Humana Plans in New York
|
:: Top
|
Example 2: 2012 Plan no longer offered in 2013
This California beneficiary wants to which plans will no longer be offered in 2013. They enter California in the State field (which is a required field) and click the checkbox next to Only Show Plans that will be Discontinued in 2013. They can leave the rest of the search fields empty and then click on Click to Compare Annual Plan Changes.
Our beneficiary can quickly see details of the five (5) plans that will no longer be offered in California for 2013. Members of these plans may be automatically enrolled in a different plan by their insurance carrier unless they choose a new plan for themselves (Details can be found in the Annual Notice of Change sent directly to members by the carrier).
Our California beneficiary can see that over 200,000 people in California are currently enrolled in plans that will be discontinued in 2013 -- with over 198,000 of those people in the Advantage Star Plan by RxAmerica.
|
:: Go to PDP-Compare to see this example: Discontinued Plans in California
|
:: Top
|
Example 3: Change in Plan Coverage from 2012 to 2013
In this example our New York beneficiary wants to see what changes they can expect in their current plan. We have selected New York as our state. Note that State is the only field that must be entered prior to a search. Since the beneficiary is only interested in WellCare Plans, we can narrow down the comparison by selecting WellCare in the Plan Family field. We have left all other criteria fields empty. Then click on "Click to Compare Annual Plan Changes"
The comparison of the two WellCare plans is shown for both 2012 and 2013. Our beneficiary can see that if the stay with their WellCare Classic plan for 2013, they will no longer have a $310 deductible and their premium will be only $6 higher. The WellCare CMS Ratings are shown. Also shown is the Plan ID (a code that uniquely identifies the plan) and the enrollment figures for each plan.
|
:: Go to PDP-Compare to see this example: WellCare Plans in New York
|
:: Top
|
Example 4: Advanced Search - Comparing Plans from Different Companies.
Our Arizona beneficiary wants to find a medium priced Medicare Part D plan and wishes to compare plans across different companies. Since there are 34 plans in Arizona, this comparison list could be a bit cumbersome. Our beneficiary does not want to spend more than $35 per month and does not want to pay a deductible.
This type of search is done by first selecting the State Arizona, and then entering our value 35 in the Maximum Premium field in the 2013 column and 0 in the Maximum Deductible field in the 2013 column. Since we want a medium priced plan and have entered our max, lets let the low priced plan fall to the bottom of the list by selecting 2013 Premium Highest to Lowest in the Sort Results by field. Then click on "Click to Compare Annual Plan Changes"
Our comparison is reduced to only 4 plans rather than 34.
We can quickly compare the CMS Quality Rating, Premiums, Copays and Coinsurance, and even Plan Popularity across these plans. We can even see the individual plan changes from 2012 to 2013.
|
:: Go to PDP-Compare for Arizona and enter 28 in the 2012 max premium and 0 in the 2012 max deductible -- sort by 2012 premium highest to lowest
|
:: Top
|
Example 5: Advanced Search - Premium increases in California
In this example our California beneficiary wants to see the changes in the most inexpensive Medicare Part D plans. We enter California in the State field, 35 in the 2012 Maximum Premium field, 310 in the 2012 Maximum Deductible field (or leave it blank since $310 is the 2012 maximum deductible. We entered 40 in the 2013 Maximum Premium field, 320 in the 2013 Maximum Deductible field (or leave it blank since $320 is the 2013 maximum deductible. We changed the Sort Results by field to 2013 Premium Highest to Lowest.
Our comparison show two plans that meet our search criteria. All four plans raised their deductible $10. The Bravo plan increased $5.10 and no longer qualifies for the LIS $0 premium. The three plans under $32 still qualify for the LIS $0 premium and for non-LIS recipients. The Health Net Orange plan increased $1.60. The WellCare Classic plan's premium remained the same and the Humana Walmart-Preferred plan raised their premium $0.30. The co-payments/co-insurance for both plans can quickly be compared to determine which plan best matches the prescription purchase patterns for the beneficiary.
|
:: Go to PDP-Compare for California. For max premium enter 35 in 2011and 40 in the 2012 -- sort by 2012 premium highest to lowest
|
:: Top
|
Chart Key: What do all of the Chart Fields Mean?
Below is a key or legend for the PDP-Compare Comparison Chart. The same key is shown just after the PDP-Compare Chart once you click on the Search button.
A few notes to help with the understanding of the Medicare Part D Prescription Drug Plan chart above and Search Tips to help you narrow down your list of plans to those that best meet your needs.
- Plan Name: This is the official plan name from CMS. The same plan name generally has a different plan id in each state. (Search Tip: If you would like to reduce the plans shown to just plans for one or two specific carriers, you can select the carrier name in the "Plan Family" fields 1 and 2. Select the empty (blank) option at the top of the list to remove the criteria. You can also click the "National Plans" checkbox to limit your search to just national plans.)
|
|
|
- CMS Plan Ratings: these are found under the Plan Name at the left side of the chart.
This is a 1 to 5 star rating system with five (5) stars as excellent, four (4) stars as very good, three (3) stars as good, two (2) stars as fair and one (1) star as poor.
Cust. Service Rating - Drug Plan Customer Service - Medicare and members rate the drug plan and how well a drug plan provides customer service.
This category includes measures of how drug plans rate on the following areas:
- Time on Hold When Customer and Pharmacist Calls Drug Plan.
- Calls Disconnected When Customer and Pharmacist Calls Drug Plan.
- Drug Plan’s Timeliness in Giving a Decision for Members Who Make an Appeal.
- Fairness of Drug Plan’s Denials to a Member’s Appeal, Based on an Independent Reviewer.
|
|
|
- Member Plan Exper. - Member Experience with Drug Plan - This category shows how well drug plans make prescription drugs available to their members.
This category includes measures of how drug plans rate on the following areas:
- Drug Plan Provides Information or Help When Members Need It.
- Members’ Overall Rating of Drug Plan.
- Members’ Ability to Get Prescriptions Filled Easily When Using the Drug Plan.
|
|
|
- RxCost Info Rating - This category shows how well drug plans are doing with pricing prescriptions and providing information on the Medicare website.
This category includes measures of how drug plans rate on the following areas:
- Completeness of the Drug Plan’s Information on Members Who Need Extra Help.
- Drug Plan Provides Current Information on Costs and Coverage for Medicare’s Website (the same data is used on this Q1Medicare.com).
- Drug Plan’s Prices that Did Not Increase More Than Expected During the Year.
- Drug Plan’s Prices on Medicare’s Website (and this website) Are Similar to the Prices Members Pay at the Pharmacy.
- Drug Plan’s Members 65 and Older Who Received Prescriptions for Certain Drugs with a High Risk of Side Effects, when There May Be Safer Drug Choices.
|
|
|
:: Top
|
- Monthly Premium: This is the amount you must pay each month to use the plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase. (Search Tip: If you would like to reduce the plans shown to just plans under a certain premium, enter this value in the "Maximum Premium" field.)
- Deductible: This is the $ deductible that was presented in the CMS Standard Plan. Many provider’s plans do not have a deductible, however the premium may be higher. (Search Tip: If you would like to reduce the plans shown to just plans with a deductible under a certain value, enter this value in the "Maximum Deductible field" field.)
- Gap Coverage: the Donut Hole: In the CMS Standard Plan, the beneficiary must pay the next $ in drug costs (the Donut Hole). The Healthcare Reform provides that for Plan Year , ALL formulary generics will have at least a 0% discount and ALL brand drugs will have at least a 0% discount in the coverage gap. The Gap Coverage Types discussed in this section are in addition to the Healthcare Reform mandated discounts. In our chart, you will see one of the following:
- No Gap Coverage: you must pay the $;
- Few Generics: less than 10% of formulary generics are covered, but you must pay for Brand Drugs up to $;
- Some Generics: 10% to 65% of formulary generics are covered, but you must pay for Brand Drugs up to $;
- Many Generics: 65% to 100% of formulary generics are covered, but you must pay for Brand Drugs up to $;
- All Generics : All formulary Generics are covered, but you must pay for Brand Drugs up to $;
- Many Generics & Some Brands: These Medicare prescription drug plans cover 65% to 100% of formulary generics and a some (10% to 65%) of Brand drugs on the plan’s formulary.
- Some Generics & Some Brands: These Medicare prescription drug plans cover 10% to 65% of Generic and Brand drugs on the plan’s formulary. (Search Tip: If you would like to reduce the plans shown to just plans with a certain type of gap coverage, select this type of coverage in the "Type of Gap Coverage" field.)
- $0 Premium with Full LIS - Does the plan Qualify for $0 Premium with Full Low-Income Subsidy?: If Yes is in the field, then you would pay a $0 premium if you have a Full Low-Income Subsidy (LIS). If No is in the field, then you would be responsible for the difference between what the state provides as the Full Low-Income Subsidy and the actual cost of the plan even if you have a Full Low-Income Subsidy. (Search Tip: If you would like to reduce the plans shown to just plans that qualify for the $0 premium (Benchmark plans), select "Yes..." in the "Full Low-Income Subsidy?" field.)
- Plan ID: This is the unique id for this particular plan.
|
|
|
:: Top
|
- Copay / Coinsurance - Cost Sharing - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on which tier the drug is in. Plans can form their own tiers, so you should contact the plan or reference it’s summary of benefits to find out what copays and limitations are associated with each tier. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. (Search Tip: If you would like to reduce the plans shown to just plans that have a tier 1 (Generics) co-pay of up to a certain value (ex: $0 co-pay), enter the value (ex: 0) in the "Max. Co-pay Tier 1 (Generics)" field.)
|
|
|
Additional Information Fields:
You can select one of the following additional pieces of plan information to display (Search Tip: to change the type of information shown in the last column of the chart, select the data to be shown in the "Additional Info" field.)
- Total Formulary Drugs (default) - This is the total number of medications on the plans formulary or drug list. For 2013 Medicare Part D plans, the smallest formulary is the EnvisionRxPlus Silver (PDP) formulary with 2,380 total medications and the largest formulary is the AmeriHealth Rx Option II formulary (PA & WV) with 4,985 total formulary drugs. This total drug count does not include "Bonus Drugs". These are non-Medicare Part D drugs which are covered by the plan, however they do not count toward your plan deductible, retail drug cost, or TrOOP.
- Offers Mail Order - "Yes" is displayed if this plan offers mail order on any medications. It does NOT mean that ALL medications are available through mail order.
- Members in This State (updated: figures) - This is the total number of members in this plan for this CMS Region. For regions which contain more than one state, this is the total for all of those states combined. We are showing the latest Medicare Part D plan enrollment figures. We update this figure as new enrollment statistics are released by Medicare.
- Members Nation Wide (updated: figures) - This is the total number of member for this plan in all CMS Regions (States) combined. We are showing the latest Medicare Part D plan enrollment figures. We update this figure as new enrollment statistics are released by Medicare.
|
|
|
- Initial Coverage Limit (ICL) - The initial coverage limit phase of a Medicare Part D plan is the phase AFTER the initial deductible is met (if the plan has an initial deductible) and BEFORE the coverage gap (or donut hole) begins. The ICL is the phase of the prescription drug plan during which you and your plan share your prescription costs. During this phase you will pay either a co-payment (a flat fee per prescription) or co-insurance (a percentage of the drug cost). The details of the cost-sharing for the plan are shown in the Cost-Sharing column directly to the left of this column. The CMS standard Initial Coverage Limit for is $ and increases each year.
- National or Regional Plans - This column simply displays the word "National" if the plan is sponsored by a national carrier or "Regional" if the plan sponsor is a regional carrier.
|
|
|
(Chart Source: various files provided by the Centers for Medicare and Medicaid Services along with data from the Medicare.gov website plan finder.)
Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, we cannot guarantee the accuracy of this information.
|
|
|
|
|
|
|
|
|
|
|
Click the +1 button if you have found this page useful:
|
|
|
|
|
Medicare Supplements
fill the gaps in your
Original Medicare
|
|
|
|
|
|
|
|
|
