Using the Medicare Plan Finder: Part I

Published Sep 30, 2018 at 9:00am

it is that time of year again, the start of the Medicare Open Enrollment period.

During this period almost everyone, both those who are old and new to Medicare, should review their coverage. Medicare has provided everyone with computer access to a highly useful tool for this purpose, the Medicare Plan Finder.

To discuss Plan Finder, I have asked Bonnie Natarelli, a case manager and HIICAP counselor with the Oneida County HIICAP program, to help us understand how to get the most out of Plan Finder. Bonnie is a graduate of MVCC and has been a counselor with the HIICAP program since 2015. I conducted a telephone interview with Bonnie a few weeks ago.  

Let’s start with the most basic question, how do you log onto the Medicare Plan Finder? 

According to Bonnie, to log onto Plan Finder you first go to Medicare.gov, the Official U.S. Government Site for Medicare. You will find three green bars. “The first bar, Find Health and Drug Plans, is the most used by HIICAP Counselors. The second bar is Apply for Medicare while the last bar is Get Started with Medicare.”

At the very top Plan Finder is a Main Menu tab where you can change plans, find Medicare cost and coverage, access claims/appeals information as well as forms and resources. “Farther down on the home page one can find information on finding doctors, health care providers, hospitals, plans and suppliers in your area.”

To do a general, exploratory search for information select Find Health and Drug Plans and enter your zip code. When they ask for additional information click “I don’t know.” Follow the additional instructions. If you have your Medicare card and want to do a personal search, enter all your personal information. We will discuss doing personal searches later in the article.

Could you please tell our readers how you and other HIICAP counselors use Plan Finder? Counselors use Plan Finder to assist clients in finding the best available drug or Medicare plan. Everybody’s medications are different and each plan has a different formulary (the listing of which drugs they cover) and cost.

There is also the issue of how much you are willing to pay. “Every plan tiers their medications differently, especially diabetic meds. For example, we have found that one plan will not cover one brand name but will cover another. So, you have to play around.” Medicare.gov can also be used for locating a durable medical equipment supplier in your area.

How should Medicare beneficiaries who are new to Part B use Plan Finder? Those new to Medicare should go on Plan Finder and check out what is out there. Many people who are working are delaying signing up for Medicare Part B until they retire. You can go into Plan Finder 3 months before you turn 65 and do a personal search.

“The personal search consists of entering your zip code, Social Security number, last name and effective date of Medicare Part A and your date of birth. This information will bring up Medicare and what information Medicare has on you, Original Medicare, your current plan if you have one, any Extra Help you are receiving and if you have both Medicare and Medicaid.

Next you would enter all the medications you are taking. You should choose one/two pharmacies you might use even if you plan to use a mail order service as prices vary. Plan Finder will assist you in seeing what plans in our area will work for you. Plan Finder also allows you to see if the Medications are on the plans formulary, how they are tiered and what pharmacies work best with the plan.”

While you can do all of these things on your own, and many do, HIICAP counselors can work with you to enter all of this information and help you make an informed choice. For example, should I choose Original Medicare and a Part D plan or a comprehensive Medicare Advantage Plan? What Part D plan will work best for me? Which plans are accepted by my physicians?

Counselors will be able to tell you which practice groups accept which plans. They will make a call to private doctors’ offices to confirm the information if necessary. When someone comes into one of your sites, what should they bring with them? When you come to a HIICAP counseling appointment, bring your new Medicare card, proof of income and a list of your medications.

“We screen all our clients for several programs, including Extra Help and the Medicare Savings Program. If a client is age 65 or over, and is single with an income under $75,000, or married with an income under $100,000, we will also discuss the New York State EPIC program.”

It is not necessary to use Plan Finder before you come in to see a counselor. If you have some major health problems which requires you to see multiple doctors often, it may be best to look at Original Medicare and a supplemental insurance plan instead of an Advantage plan. Counselors will give you several options so you can really think about your costs. 

I would like to thank Bonnie for agreeing to do this very informative interview. Because of the space limitations, we could not cover everything we wanted to in one column. So, Part II of this interview will appear in the November issue. 

Help is always available in Oneida County to answer all your insurance questions. Whether you are new to Medicare or have been covered for a number of years, Bonnie and the other counselors at The Oneida County Office for the Aging/Continuing Care/NY Connects Health Insurance Information, Counseling and Assistance program (HIICAP) offices can answer questions. These services are provided at no cost to all Medicare beneficiaries. HIICAP offices are found at the following locations:

Ava Dorfman Senior Citizens Civic Center, 305 E. Locust St., with hours of operation on Tuesday and Thursday from 10 a.m. to 2 p.m. While consumers are seen on a “first come, first served” basis you may call the Dorfman Center at 315-337-1648 to see if there are long wait times.

North Utica Senior Citizens Community Center, 50 Riverside Drive, Utica with hours of operation on Monday, Wednesday and Friday from 10 a.m. to 2 p.m. Consumers are counseled on a “first come, first served” basis. However, if you want to call ahead to see how busy the office is you may call the Center’s HIICAP program at 315-724-8680.

HIICAP services are provided by Oneida County Office for Aging and Continuing Care/NY Connects. Anyone with questions about HIICAP, including issues with your Medicare Advantage Plan, should call the program directly at 315-798-5456 and press 4 in the choice list. It will direct you to someone who can assist you.

Dr. William Lane is the owner of William Lane Associates, a gerontological consulting firm now based in Homer, NY. He is writing a monthly column on issues related to health insurance for the OFA. He does not sell insurance, work for any insurance company or recommend any insurance products.