Q1Medicare.com Announces a New Section on Understanding Your Medicare Part D Explanation of Benefits

Saint Augustine, Florida (PRWEB) July 28, 2011

Q1Medicare.com has now added an online section dedicated to helping seniors and other Medicare beneficiaries better understand their Medicare Part D prescription drug plan?s Explanation of Benefits document. The new Q1Medicare.com section can be found directly at Q1Medicare.com/EOB.

Every Medicare Part D prescription drug plan is required to provide their plan members with an Explanation of Benefits (EOB) summarizing the member?s monthly prescription drug purchases and showing any changes that will be made to the member?s plan coverage. The Explanation of Benefits letter is separated into six sections with details about the Medicare beneficiary?s covered drug purchases since the last EOB letter, including the cost allocation for those purchases covered in Section 1. The EOB also shows the beneficiary?s current prescription drug plan coverage stage and their progress toward the next coverage stage in Section 2; as well as the beneficiary?s out-of-pocket costs and total drug costs in Section 3.

Section 4 of the Explanation of Benefits letter includes any formulary changes that affect the beneficiary?s medications. For instance, Section 4 can include the removal of drugs from a plan?s formulary, or the addition of, or changes in, drug usage restrictions such as step therapy, quantity limits or prior authorization. Section 4 will also show a beneficiary if their medications are moving from one cost-sharing tier to another. Q1Medicare.com/EOB Sections 4 not only explain how a member?s formulary can change, but also provides the member with information and links on how to request a formulary exceptions, should they wish to request an exception to the plan?s change. Sections 5 and 6 of the EOB explain administrative topics such as errors and beneficiary rights.

?From the questions and comments we receive, we find that Section 4 is one of the most important, and often most overlooked, sections of the Explanation of Benefits,? notes Dr. Susan Johnson, Technical Director and co-founder of Q1Group LLC. ?Unfortunately, although an Explanation of Benefits letter is well organized, it seems that many people use their EOB to review their past purchases and their present plan stage, but rarely do they notice that Section 4 shows them the future of their drug coverage.?

The new Q1Medicare.com Explanation of Benefits section is organized according to the six sections that a Medicare beneficiary will find in their own printed Explanation of Benefits letter and includes tips and answers to frequently asked questions about the EOB. For instance, Seniors trying to see where they are in comparison to the Coverage Gap or Donut Hole portion of their drug plan can use the Q1Medicare.com?s EOB Section 2 to find more information. Medicare Part D beneficiaries are also encouraged to submit their own EOB related questions should they need more information.

About the Q1Medicare.com Website

Q1Medicare.com is one of the largest independent online resources for Medicare Part D prescription drug plan and Medicare Advantage plan information. Q1Medicare offers a large section of Frequently Asked Questions, online tools, and a free Medicare Part D Newsletter all designed to help Medicare beneficiaries, caregivers, advocates, advisers, and insurance agents better understand both the Medicare Part D prescription drug and Medicare Advantage programs.

Q1Medicare.com is operated by Q1Group LLC (Saint Augustine, Florida).

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Q1Medicare.com Brings Medicare Part D Prescription Drug Plan Exceptions, Appeals, and Grievance Section Online

Saint Augustine, FL (PRWEB) July 13, 2011

Q1Medicare.com has now added an online section to help Medicare beneficiaries and caregivers understand the processes involved with Medicare Part D Exceptions, Appeals, and Grievances.

All members of Medicare Part D prescription drug plans have the right to request a Formulary Exception or Coverage Determination from their Medicare Part D plan. A Formulary Exception is a request for a specific change in plan coverage and can be made for several reasons. For instance, a Medicare beneficiary may request that a non-formulary medication be covered by their drug plan or a person may ask that their medication be moved to a lower cost-sharing tier or they could request a change to a specific utilization management restriction. However, not all exceptions are allowed. For instance, a person cannot ask that their Medicare Part D plan cover a medication that is specifically excluded from the Medicare Part D program.

Usually a person, their physician or their appointed representative, can file an exception. However, a Formulary Exception is usually not successful without some assistance from the physician or the medication prescriber. If a person?s health is at risk, they can also ask that their exception be given an expedited or faster review. Generic forms to file a written exception can be downloaded at: Q1Medicare.com/ExceptionForms, although some plans may require the use of their own exception forms.

Medicare Part D plans do not automatically grant a request for a Formulary Exception or Coverage Determination. If a request for a Formulary Exception is denied, the Medicare beneficiary can challenge their plan?s decision through five different appeal levels, starting with the Medicare Part D plan itself and ending with a Federal Court. A chart showing the different levels of appeal can be viewed at: Q1Medicare.com/AppealsChart.

A Medicare beneficiary also has the right to file a complaint or grievance with their Medicare Part D plan. For instance, if a Medicare Part D plan does not respond to a request for an exception or an appeal on a timely basis, the Medicare beneficiary can telephone their plan and file a grievance. A list of other common grievances can be viewed at: Q1Medicare.com/Grievance.

?We hear from many people who are still unaware that they can request changes to their Medicare Part D coverage or they are simply intimidated at the thought of challenging their plan?s decision,? notes Dr. Susan Johnson, Technical Director and co-founder of Q1Group LLC. ?We are hoping that our new section will help Medicare beneficiaries understand more about Exceptions, Appeals, and Grievances and realize that these procedures have been put into place to insure their access to appropriate health care.?

About the Q1Medicare.com Website

Q1Medicare.com is one of the largest independent online resources for Medicare Part D prescription drug plan and Medicare Advantage plan information. Q1Medicare offers a comprehensive section of Frequently Asked Questions, online tools, and a free Medicare Part D Newsletter all designed to help Medicare beneficiaries, caregivers, advocates, advisors, and insurance agents better understand the Medicare Part D and Medicare Advantage programs. Q1Medicare.com is operated by Q1Group LLC (Saint Augustine, Florida).

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Q1Medicare.com Launches Enhanced Medicare Prescription Drug Plan Formulary Browser

Saint Augustine, Florida (PRWEB) August 31, 2011

Q1Medicare.com launched their enhanced Medicare prescription drug plan Formulary Browser providing users with easy access to all Medicare prescription drug plan formularies used by Medicare Advantage that offer prescription drug coverage (or MAPDs), stand-alone Medicare Part D plans (or PDPs), and even Medicare Special Needs Plans (or SNPs). The enhanced Q1Medicare.com Formulary Browser also now offers members of the Medicare community four different ways to find their desired formulary depending on the user?s needs and expertise.

Medicare beneficiaries who are looking for a specific stand-alone Medicare Part D plan formulary or Medicare Advantage plan formulary, can simply select their state, the name of their Medicare Part D plan carrier, and then the name of the specific Medicare plan. Although Medicare Advantage plans are organized on a county-by-county basis, Medicare beneficiaries are still given the opportunity to search state-wide for Medicare Advantage plans offered by a specific Medicare plan carrier and all available Medicare Advantage plans are shown sorted by county name.

If someone wants a more specific geographic formulary search, the Formulary Browser user can also find their Medicare Advantage plans or Medicare Part D plan formulary by ZIP Code by selecting the ?ZIP & Plan? search. Since Medicare Part D plans are offered on a state-wide basis, any ZIP Codes will show all the stand-alone Medicare Part D plans offered by a particular Medicare plan provider across that entire state. However, since Medicare Advantage plan are county-specific, users may need to select their resident county when their ZIP Codes includes more than one county.

The Formulary Browser also has several searches designed for medical, pharmaceutical, and healthcare professionals who have access to Medicare plan information that is not specific to a geographical area or when they are assisting geographically dispersed Medicare beneficiaries. Professionals or technically savvy seniors can search by the Medicare plan Contract ID and Plan ID to find a specific Medicare plan?s formulary by selecting the ?PlanID? search. Alternatively, healthcare professionals can search the Formulary Browser by entering just the eight-digit Formulary ID by selecting the ?FormularyID? search. Both the Contract ID/Plan ID and the Formulary ID search results will return the geographical service area for the plan in question along with the Medicare plan?s formulary details and the actual plan features.

Once a formulary is found, the user can then browse through the formulary alphabetically. The Formulary Browser provides results in a chart with the medications listed along with prescription strengths, drug tier and tier description, preferred pharmacy and mail-order cost-sharing or co-payment amounts, and details on drug usage management. The site user is also shown detailed information about the specific Medicare plan including the plan?s monthly premium, deductible and if the plan qualifies for the full Low-Income Subsidy $ 0 monthly premium.

?We enhanced our Formulary Browser based on the feedback we received from our Q1Medicare.com users who wanted different ways for finding a specific Medicare plan?s formulary,? notes Dr. Susan Johnson, Technical Director of the Q1Medicare.com site and co-founder of Q1Group LLC. ?We also found that, as our site has grown, people were asking that we begin to integrate our different online tools so now our Formulary Browser is linked to the Medicare plan?s health and drug benefit details, our plain text description of the plan, and even the Medicare plan?s contact information.?

The Formulary Browser is available at no cost and designed for computer, smartphone and tablet platforms. The results of the enhanced Formulary Browser are also formatted to be printed for offline use. Users can find the Q1Medicare.com Formulary Browser directly at: Q1Medicare.com/FormularyBrowser.

About the Q1Medicare.com Website

Q1Medicare.com is one of the largest independent online resources for Medicare Part D prescription drug plan and Medicare Advantage plan information. Q1Medicare offers a large section of Frequently Asked Questions, online tools, and a free Medicare Part D Newsletter all designed to help Medicare beneficiaries, healthcare professionals, advocates, advisers, and insurance agents better understand both the Medicare Part D prescription drug and Medicare Advantage programs. Q1Medicare.com is operated by Q1Group LLC (Saint Augustine, Florida).

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Q1Medicare.com Introduces Simplified Medicare Advantage Plan Search Tool

Saint Augustine, Florida (PRWEB) July 25, 2011

Q1Medicare.com now offers an easier way for Seniors and other members of the Medicare community to review 2011 Medicare Advantage plans or Medicare Health plans online. Using the Q1Medicare.com/MA-Finder, Medicare beneficiaries simply enter their ZIP Code and view all 2011 Medicare Advantage plans available in their county, along with key Medicare Advantage plan coverage details, such as monthly plan premiums, deductibles, 30-day supply cost-sharing information for all drug tiers, and Part A and Part B maximum out of pocket limits (or MOOP).

The MA-Finder includes Medicare Advantage plan coverage details for Medicare Advantage plans with and without Medicare Part D prescription drug coverage. Medicare Advantage Special Needs plans or SNPs are also included within the search results.

MA-Finder users can also browse through all of the counties within a state and see highlighted plans showing the lowest cost plans with prescription drug coverage for each health coverage type (such as HMO, PPO, or PFFS) and a link to a complete list of Medicare Advantage plans in the county. As an example, users can go to Q1Medicare.com/MA-Finder/FL, and if they click on the ?All MA-PD plans in Broward County, FL? link, the user would see a comparison of all 91 Medicare Advantage plans available within the county.

Users of the Q1Medicare MA-Finder can also choose to compare additional features of the available Medicare Advantage plans by changing the ?Additional Info? field in the search preferences box. Key information such as the number of plan members, the number of drugs on the plan?s formulary, or the plan?s initial coverage limit can be viewed. More advanced users can also filter the MA-Finder search results based on monthly premium, maximum deductible, Donut Hole coverage, plans with $ 0 cost-share on tier-one drugs, and/or SNP eligibility requirements, to name a few.

If the MA-Finder user would like to learn more about a specific plan, they can click on the ?detail? icon below the Medicare Advantage plan name to review complete coverage details that include both the health and prescription drug coverage. The MA-Finder also includes a ?T? icon for each Medicare Advantage plan, allowing users to read about the chosen Medicare Advantage plan?s coverage in ?simple text? rather than in chart format.

?Just like our prescription drug plan finder, our Medicare Advantage plan search tool or MA-Finder is designed as an easy to use alternative to other more complicated online search tools,? notes Dr. Susan Johnson, Technical Director and co-founder of Q1Group LLC. ?Our MA-Finder provides users with a comparison of plans available along with links to coverage details, enrollment and contact information, and even a narrative text version of the plan coverage.?

The Q1Medicare.com MA-Finder tool is available free of charge to all site users and the results of any search can be eMailed to the user for further review offline. The MA-Finder and all other Q1Medicare.com tools can also be accessed on smartphone or tablet platforms. The Q1Medicare.com Medicare Advantage plan search tool can be found directly at MA-Finder.com.

About the Q1Medicare.com Website

Q1Medicare.com is one of the largest independent online resources for Medicare Part D prescription drug plan and Medicare Advantage plan information. Q1Medicare offers a comprehensive section of Frequently Asked Questions, online tools, and a free Medicare Part D Newsletter all designed to help Medicare beneficiaries, caregivers, advocates, advisers, and insurance agents better understand the Medicare Part D and Medicare Advantage programs. Q1Medicare.com is operated by Q1Group LLC (Saint Augustine, Florida).

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