PCHI Decision Support for Medicare D
Partners Community HealthCare Inc. is providing online resources for physicians to share with their patients to help them navigate the complicated changes in Medicare. As of this month, prescription drug coverage is available to beneficiaries with Medicare. Medicare beneficiaries must enroll in a Medicare drug plan to obtain prescription drug coverage with a choice of two types of Medicare drug offerings.
The Medicare Advantage plans [HMO, PPO, or a Private Fee for Service (PFFS) Plan] include drug coverage as part of their offered plan. Therefore, beneficiaries receive all their health care, including prescription drug coverage, through these plans. Medicare Prescription Drug Plans (PDPs) add prescription drug coverage to existing Medicare plans that currently cover medical expenses. Insurance companies working with Medicare offer these prescription plans. Anyone currently enrolled in Medicare will be eligible for drug coverage under Medicare Part D.
For all drug coverage plans, the formularies or preferred drug listings will be independent of one another and may be changed periodically. As of Nov. 17, there are 61 different prescription drug coverage plans offered within New England. Monthly premiums, formularies and deductibles vary from plan to plan. Beneficiaries will need to review the individual plans to make sure their drug is included.
To help beneficiaries choose the most appropriate plan, Medicare developed a Web-based tool that compares the various prescription drug plan available at www.medicare.gov
Physicians can use a PCHI calculator to estimate a patient’s yearly medication costs and potential savings with the Medicare Part D Prescription Drug Plan. The PCHI calculator is based on the standard prescription drug benefit set by Medicare and will help in estimating beneficiary’s cost with if Medicare
Part D were selected for drug coverage.
This calculator is designed to provide a general estimate in annual medication costs and savings and provide physicians an overview of the benefits Medicare Part D provides to seniors.
Additional Resources
• 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048.
• The SHINE Program, a state health insurance assistance program, 1-800-243-4636, select option ‘2’. TTY: 1-800-872-1066
• MassMedLine: 1-866-633-1617.
• Prescription Advantage: 1-800-AGE-INFO or www.ageinfo.com
• Medicare Rights Center: www.medicarerights.org/Index.html
• Massachusetts: In state calls: 800-882-2003; 617-727-7750; TTY: 800-872-0166
PCHI Medicare Part D Calculator:
http://ppd.partners.org/scripts/phsweb.swl?APP=PORTAL
Go to References tab (top of page)
Pharmacy link (left side of page)
Scroll to find: Medicare Part D Cost Savings Calculator