Amplicare Match helps you compare Medicare plans with prescription drug coverage for your patients. That includes standalone Prescription Drug Plans, Medicare Advantage plans with Prescription Drug Coverage, and Special Needs plans with Prescription Drug coverage. Here are the top reasons you may not see a plan listed in the Medicare tab.
The plan is not a public Medicare plan. In Amplicare Match, we display public Medicare plans that anyone eligible for Medicare can enroll in. Private group Medicare plans, such as those associated with an employer, won't be listed. You can usually tell if a patient is on a private group plan by the Plan ID. Plan IDs follow the format S1234-123. If the part after the dash begins with an "8," that's a pretty good sign this is a private group plan (i.e. S1234-801 is a private group plan!).
The plan is a regional plan, and is not active in the patient's ZIP Code. All plans have regional differences, and some plans are active only for patients in specific counties or regions. Remember, the plans available for a patient to enroll in depend on their residential ZIP Code, not the pharmacy's. Because of this, if you have patients from multiple counties, you may see different plans listed between patients. If your pharmacy is on a border, don't be too surprised if the plans listed for your patients across state lines are very different than for in-state patients.
CMS does not accurately reflect your contracting. Your in-network status with a plan can happen two ways: by self-contracting with a plan, or by contracting through a PSAO. We receive your plan network data from CMS, so if a plan or your PSAO does not accurately report your contracted status to CMS, you may end up incorrectly listed as "out-of-network." CMS is a large government organization that can take a few months to update their data, so if you recently contracted with a plan or switched PSAOs CMS data may not reflect that. If you notice a plan you're contracted with is missing from Amplicare, reach out and we can update our system so you won't have to wait on CMS!
Lastly, make sure a plan you're looking for hasn't been discontinued or changed names.
If you have any questions about the plans listed in Amplicare for your pharmacy, chat us via the blue chat icon on the right, or email us at email@example.com.