1.How can you find the patient's current plan?
Click on the "Check Enrollment Button", enter the patient's Medicare information and it will let you know what plan the patient is currently on.
2.Why can't plans be searched by BIN or PCN numbers?
BIN and PCN numbers are only used for billing purposes. For example, all Aetna plans use the same BIN number, making it impossible to determine if your patient is on Aetna Medicare Saver or Aetna Medicare Premier. What you really need to find is the full plan ID number, which is what we have listed in iMedicare, so you have the most accurate information for the patient. If you did want to reference the BIN and PCN numbers corresponding to plans, you can access a downloadable list under the reports tab in web.imedicare.com.
3.How do you find the DIR and reimbursements for each plan?
You can view reimbursements and DIR fees by clicking the Options Box above the list of all of the plans and then selecting the box to check off "Show Full Refill Cost". Then it will reflect next to each plan as a RED NUMBER.
4.Are the reimbursements per National Drug Code (NDC) or per drug?
Once "Show Refill Full Cost" is selected and you go to the monthly breakdown, the left hand number next to the drug will show the patient's copay on the medication and the right hand number will show the pharmacy's reimbursement on that drug.
5.When can a Dual Eligible patient sign up for a plan?
A dual eligible patient is able to switch plans once every month.
6.When comparing plans for a Dual Eligible patient, why are some premiums greater than 0 and why don't they pay 0 in copays for all plans?
Dual Eligibles have various subsidy amounts (reflective of their income around the Federal Poverty Line) that affect how much they pay. Based on their subsidy, their copays will be 0, 1.20 & 3.60, or 2.65 & 6.60. Duals will only receive a $0 premium if they choose a plan that is a benchmark plan in your state. A state sets a certain amount (benchmark rate) that they will pay for a plan's premium for a Medicaid patient. If the Medicaid patient's plan's premium is above that benchmark rate, they will pay for the remainder of the premium. (Ex. A state benchmark rate is $30 but the patient's plan premium is $35, the patient will pay $5)
7.How do you find a therapeutic alternative if a drug is not covered?
If a drug is not covered, it will be highlighted in red. To find an alternative simply click on the drug that is highlighted in red. Then, you will see a tab called therapeutic alternatives. Once you select that tab the list of all the alternatives as well at their tier numbers will be listed. You will also be able to see any drugs that still will not be covered on the plan in place of that medication.
8.How do you know a patient's phase of coverage for each month of the year?
When comparing plans by their monthly breakdown: Red P = Pre-Deductible, Green I = Initial Coverage, Red G = Gap Coverage/ Donut Hole, Green C = Catastrophic Coverage. Yellow indicates that they reached a new coverage stage during that month.
9.Where do you find the newly eligible patient letters?
Newly eligible patients letters will be located under the reports tab. You can access a list of patients who are Eligible for Open Enrollment, a list of patients turning 65 in 3 months, and a list of patients turning 65 in 6 months.
10.What percentage of patients should change plans each year?
80% of Medicare patients should change plans each year, as they are not on the most affordable plan.