As healthcare plans become increasingly complex, it’s essential for pharmacists — the most accessible healthcare provider — to be well-versed in the different options available to their patients. And with 54 percent of all Medicare beneficiaries using a Medicare Advantage plan, pharmacists across the country need to know the ins and outs of the program.
Do you feel intimidated when it comes to discussing Medicare Advantage plans with your patients? This article is for you. Let’s demystify Medicare Advantage.
Medicare Advantage vs. Original Medicare: An Overview
Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). It is a federal program that provides coverage for hospital stays, doctor visits, preventive services, and some home health care. Patients can see any doctor or hospital that accepts Medicare, and there are no network restrictions. However, Original Medicare does not cover everything. For instance, it does not include prescription drug coverage (Part D), dental, vision, or hearing services. Patients often need to purchase supplemental insurance (Medigap) to cover out-of-pocket costs like deductibles, copayments, and coinsurance.
Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare. These plans must provide at least the same level of coverage as Original Medicare but often include additional benefits such as prescription drug coverage, dental, vision, and hearing services. Medicare Advantage plans typically have network restrictions, meaning patients may need to see doctors and use hospitals within the plan’s network. These plans often have lower out-of-pocket costs and may offer extra benefits not covered by Original Medicare.
Want to learn more about Medicare Advantage? Watch our webinar, “Medicare Advantage & Your Patients: What Pharmacists Need to Know” featuring EnlivenHealth’s Medicare expert Marvin Guardado and Greg McKenna, RPh from Nutmeg Pharmacy in Higganum, Connecticut. Register now »
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Medicare Advantage Pros & Cons
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Medicare Advantage Open Enrollment Period
While eligible patients can enroll in a Medicare or Medicare Advantage plan during the Medicare Annual Enrollment Period (from October 15th to December 7th), those who already have Medicare Advantage plans actually have an additional enrollment period.
Medicare Advantage enrollees can make changes or switch MA plans from January 1st to March 31st. During this time, patients can switch from one Medicare Advantage plan to another, drop their Medicare Advantage plan and return to Original Medicare, or join a Medicare Advantage plan if they missed the initial enrollment period. (Patients can also switch to a Medicare Advantage plan within the first three months of enrolling in Medicare.)
This period is an excellent opportunity for pharmacists to engage with their patients, review their current plans, and help them make informed decisions about their healthcare coverage.
How Pharmacists Can Help
Pharmacists can play a pivotal role in helping patients understand their Medicare Advantage options. Here are some ways to get started:
- Educate Yourself: Familiarize yourself with the basics of Medicare Advantage and the differences between various plans.
- Engage with Patients: Initiate conversations with your Medicare-eligible patients about their current coverage and any concerns they may have.
- Provide Resources: Offer informational brochures or direct patients to reliable online resources for more information.
- Use Technology: Utilize tools like EnlivenHealth’s Medicare Match to help patients compare plans and find the best options for their needs.
Introducing EnlivenHealth’s Medicare Match
EnlivenHealth’s Medicare Match is a comprehensive tool designed to help pharmacists assist their patients in comparing Medicare and Medicare Advantage plans. This tool allows patients to compare real out-of-pocket costs based on their prescriptions, ensuring there are no surprises. By using Medicare Match, pharmacists can provide personalized plan recommendations, helping patients make informed decisions about their healthcare coverage. This not only improves patient satisfaction but also strengthens the pharmacist-patient relationship and can lead to better health outcomes.
Ensuring the Best Possible Care & Coverage
Understanding Medicare Advantage is essential for pharmacists who want to provide the best possible care for their patients. By becoming comfortable with Medicare Advantage plans, pharmacists can play a vital role in improving patient outcomes and satisfaction.