This is probably the most important advice. It is a violation of CMS regulations to steer patients, but your advice is still extremely valuable. Let's look at Dos and Don'ts:
- Do show multiple plan options to the patient. Patients need to make the decision themselves, so you need to show several options and let them decide what's right for them. Use the Patient View when reviewing plans with patients.
- Do explain that plan formularies change each year. It's important that patients understand the plan they like this year may change drastically next year. Plus, this encourages them to come back for plan comparisons every year!
- Do print out a plan comparison summary for the patient to take home with them to refer to. This way the patient has it to refer to if they ever have any questions. Do this by selecting the plans they are considering, clicking "Compare Plans", and then "Print Preview". There is also an option to email the plan comparison directly from the "Print Preview" page if you prefer.
- Do help the patient understand their of out-of-pocket cost throughout the year and restrictions associated with each plan.
- Don't use words like "Best" -- that's up to the patient to decide. Instead, you can point out objective facts, such as "This plan is cheapest" and "This plan has no restrictions".
- Don't give patients marketing material at or behind the pharmacy counter. CMS marketing guidelines mandate marketing and plan comparisons take place in common areas, presumably so patients don't confuse enrollment advice with medical recommendations.
- Don't enroll patients on their behalf without them being present--it's illegal! If they request your assistance, you can certainly complete the enrollment form together following an in-person consultation. The online form can be intimidating, so remember the plan comparison print out features a number for enrolling over the phone if patients want to enroll on their own.
Empower your patients to make educated decisions. This is a crucial step for creating trust in your community, and it saves patients from being upset by unexpected changes in their costs.
Topics to explain:
- Phases of Coverage -- What are they? When will my costs change and why? When do I hit the Donut Hole and why?
- Restrictions -- What are my restrictions? What does it mean for me? Why is my cost so high (Not Covered Drugs)?
- Late Enrollment Penalty -- What is the penalty for waiting to pick a plan?
- Enrollment windows -- When can I enroll in a Part D plan?
- Changing Costs Explained -- Patients may get upset by changing costs throughout the year. Ensure there aren't any surprises, and hand out this document to all of your Medicare patients (download in your Resources).
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