Colored tags below the plan name on each of the plans indicate the following:
- Preferred Tag: Your pharmacy offers cheaper copays on certain tier drugs (usually tier one and two) during initial coverage.
- Non-Preferred Tag: This plan is accepted at your pharmacy, but you’re not in their preferred network. While this plan isn’t known to drive patients toward mail-order or chain pharmacies, it is possible your patients could find cheaper copays in a preferred network elsewhere.
- Chain Tag: This plan is preferred at chain pharmacies, and patients may find cheaper copays during initial coverage. Furthermore, this plan will likely market to beneficiaries (with mail and phone calls) encouraging them to switch to a chain pharmacy with a preferred contract.
- Mail Order Tag: This plan tends to aggressively market to patients encouraging them to switch to mail order, and patients may find cheaper copays during Initial Coverage on Tier 1 and Tier 2 drugs by switching to mail order. Sometimes the letters are so misleading patients believe they must switch to mail order. If a patient decides to enroll in one of these plans, make sure to let them know they are not required to switch to mail order and can continue filling their prescriptions at your pharmacy.
- Benchmark Tag: This plan has a $0 monthly premium and $0 deductible for dual eligible patients. Benchmark plans vary between states.
- Gap Coverage Tag: This plan might offer limited coverage on certain drugs during the Donut Hole (AKA: Gap Coverage Period), usually reduced copays on Tier 1 drugs. Historically, plans have retracted their gap coverage without warning, so we don’t recommend relying on the gap coverage.
- Sanctioned by CMS: This plan does not allow any new enrollments. Only those patients who are already enrolled in this plan from the previous year can enroll for the following year.
Special Need Plan (SNP) Tags:
Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. There are three different types of Special Needs plans.
- I-SNP Tag: This type of plan is called Institutional Special Needs Plan. Institutional Special Needs plans restrict enrollment to Medicare Advantage eligible individuals who, for 90 days or longer, require or are expected to need the level of services provided in a long-term care facility (LTC), skilled nursing facility (SNF), a LTC nursing facility (NF), a SNF/NF, an intermediate care facility (ICF) for the developmentally disabled n inpatient psychiatric facility, or an assisted living facility (ALF). I-SNPs may also enroll Medicare Advantage eligible individuals living in the community, but requiring an institutional level of care.
- D-SNP Tag: This type of plan is called Dual Eligible Special Needs Plan. These plans enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual’s eligibility.
- C-SNP Tag: This type of plan is called Chronic Condition Special Needs Plan. This plan restricts enrollment to special needs individuals with specific severe or disabling chronic conditions.
Now that you understand what each plan tag means, dive deeper and learn about various plan restrictions so you can master plan comparisons!