Amplicare uses a complex algorithm to attempt current plan and subsidy auto-detection. However, there are limitations to this auto-detection.
This article will detail alternative ways in which you can confirm current plan and/or subsidy information before performing a plan comparison.
Confirm in the patient's "MyMedicare" account
You can help a patient determine their current plan and/or subsidy info by having them log in to their "MyMedicare" account. We advise you to walk your patients through setting up an account if they haven't already! This way they'll have easy access to all of their Medicare information at any time. It's a very straightforward process to create an account -- taking the time to help your patients with this can go a long way!
To create an account, your patients will need their Medicare information (number and effective date). After logging in to their account they must follow these steps:
Click the "My Plans & Coverage" tab
Click "Get status of your new 2020 plan choice"
A new tab will open with their Current Coverage and Current Subsidy level.
Run an eligibility check in your pharmacy management system
An alternative option is to run an eligibility check (aka "E1 query") in your pharmacy management system, which should return the patient's current plan and subsidy if they have one.
The process for running an E1 query varies by dispensing software. If you’re unsure of how to do this we recommend reaching out to your pharmacy management system.
Note: The resulting query may not specify the specific plan name, but the "contract ID". You can search this ID in the current plan selection field:
The subsidy detection will be specified by "LIS level".
LIS Level 1 = Full benefit dual eligible or full extra help ($3.60 and $8.95 copays)
LIS Level 2 = Full benefit dual eligible ($1.30 and $3.90 copays)
LIS Level 3 = Full benefit dual eligible and Institutionalized or Receiving HCBS ($0 copays)
LIS Level 4 = Partial Extra Help (the percentage of the premium that's covered is not specified in the eligibility check)
Note for Pioneer users: You must enter the patient's Social Security Number in order to run the query.
Call Medicare directly
The last resort option to confirm current plan and/or subsidy is to have the patient call Medicare directly at at 1-800-633-4227. They will need their Medicare information in order to be helped. You can try calling on behalf of the patient, but oftentimes they require you to be a legal representative of the patient in order to obtain their information.
Once you confirm the patient's information, make sure to save it into their Amplicare profile! Here's how.