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Plan shopping
Jeff Kriege avatar
Written by Jeff Kriege
Updated yesterday

Shopping overview

The HealthSherpa for Medicare Shopping page allows you to browse Medicare plans available in a particular zip code, with sorts and filters to help you select a plan:


Supported plans and carriers

We display plans across Medicare Advantage Prescription Drug (MAPD), Medicare Advantage (MA), Prescription Drug (Part D), Special Needs Plans (SNP), and Med Supp.

We display most carriers. View the full carrier list here.


Initiating shopping sessions

Starting a shopping session from a Contact's Details page:

To initiate a shopping session that's associated with a particular Contact, select the "Shop for [name]" button on the Contact Detail page:

This will launch a shopping associated with that particular Contact, whose name you'll see listed up top:

A Contact-associated shopping session will automatically pull these fields into the quoter (if you've already added them for the Contact):

  • ZIP code

  • Drug

  • Providers

  • Pharmacies

  • Extra Help / LIS eligibility setting

And if you edit any of these things during the Shopping session (i.e. adding a Drug), it will automatically update the Contact Detail.

Starting a shopping session from the ‘Shop plans’ button:

To initiate a shopping session independent from any Contacts, select the ‘Shop plans’ button located on your dashboard.

This will launch an anonymous shopping session with ‘Anon-[random digits]’ clearly visible at the top of the page.

During any anonymous shopping session, you can press the ‘Save’ button to manually associate the session with a Contact.

Note: An anonymous shopping session will remain active across tabs. To begin a fresh shopping session, select the ‘New session’ button.


Shopping session settings

You are able to include a desired effective date as well as certain eligibility criteria when shopping for plans.

Plan year

From October 1st - November 30th, a plan year filter will appear. The upcoming plan year will pre-populate but you may adjust this to the current year if needed.

Effective date

The effective date included on a Contact's Details page will automatically populate when initiating a shopping session from a Contact's Details page and may be updated if desired.

You may include or update the desired effective date for coverage using the ‘Effective date’ menu. Effective dates selected will pre-populate during enrollment while still remaining editable.

Extra Help / Low Income Subsidy (LIS) level

The Extra Help / LIS data included on a Contact's Details page will automatically populate when initiating a shopping session from a Contact's Details page and may be updated if desired.

You may include or update Extra Help / LIS eligibility using the ‘Extra Help / LIS’ menu. Learn more about Extra Help / LIS here.

Note: As of January 1st 2024, there is only one level of Extra Help / LIS so the menu includes only Yes or No options. Selecting ‘Yes’ will apply the subsidy calculations to drug deductibles, drug copays, and plan premiums.


Shopping filters

You have access to several plan shopping filters when assisting consumers with plan selection. Notable filters available within shopping sessions include Drugs, Pharmacies, and Providers.

The "My appointed carriers" filter shows only those carriers you've added to your Carriers page.


Drugs, Pharmacies, and Providers

Drugs, Pharmacies, and Providers included on a Contact's Details page will automatically populate when initiating a shopping session from a Contact's Details page and may be updated if desired.

Drugs

To add or edit drugs included in a shopping session, select ‘Add drugs’ under the ‘Drugs’ menu.

This will launch a pop-up window. You may edit existing drugs by selecting the pencil icon next to the medication name. To remove an existing drug, select the ex icon next to the medication name.

To add a new drug, simply begin keying in the name of the drug. After three characters are entered, search results will begin to populate. Customize the dosage, quantity, and frequency based on the customer’s drug then select the ‘Save’ button.

When you are done updating the drug list, select the ‘Done’ button to resume shopping.

Pharmacies

To add or edit Pharmacies included in a shopping session, select ‘Add pharmacies’ under the ‘Pharmacies’ menu.​

This will launch a pop-up window. You may include up to three pharmacies in a given shopping session.

You may remove an existing pharmacy by selecting the ex icon next to the pharmacy name. To add a new retail pharmacy, simply key in the name of the pharmacy, a ZIP code, and ZIP code radius. You may adjust the search toggle to digital pharmacies to search available digital pharmacy options.

When you are done updating the pharmacy list, close the pop-up window to resume shopping.

Note: Shopping sessions without pre-selected pharmacies will have a default Retail and Mail Order pharmacy selected. Carriers may have unique defaults. Custom pharmacy selections will override defaults listed.

Providers

To add or edit Providers included in a shopping session, select ‘Add providers’ under the ‘Providers’ menu.

This will launch a pop-up window.

To add a new provider, first enter the name or NPI of the provider and search:

Select the provider, then select the location(s) your client sees them at. (If you don't see a location you're expecting, try expanding the search radius.)

A particular provider might be in a plan's network at one location, but not another. But don't worry, if the location you select isn't in network, we'll highlight locations that are in network – right here in the plan shopping view:

Note: You can also indicate if a provider is your client's Primary Care Provider (PCP). Doing so will pre-fill the Provider's information on any enrollment forms that needs it.


Plan cards

The HealthSherpa Medicare Shopping page includes plan cards which provide you with highlights of the coverage indicated.

Notable items housed within a plan card include:

  • Total costs est.: This estimate combines a plan's monthly premium with the cost of any drugs listed in the shopping session. Total cost estimates calculate estimated costs from the effective month of the plan through December of the plan year.

    • Partial year: indicates that the Total costs estimate is accounting for only the remaining months in the year. To view the total costs estimate for a full year, select the ‘Details’ button from the plan card.

  • Drug costs est.: This is the estimated out-of-pocket costs for drugs you've listed in the shopping session. Drug cost estimates calculate estimated costs from the effective month of the plan through December of the plan year.

  • Drug tier information for drugs you've listed in the shopping session

  • The network status for any providers you've listed in the shopping session

  • Direct link to the plan’s benefits

  • Link to the plan Details page


Plan Details

The plan Details page gives you full plan information in an easy to browse format.

Notable fields within the Overview section include:

  • Total costs est.: This estimate combines a plan's monthly premium with the cost of any drugs listed in the shopping session. Total cost estimates calculate estimated costs from the effective month of the plan through December of the plan year.

    • Partial year: indicates that the Total costs estimate is accounting for only the remaining months in the year. To view the total costs estimate for a full year, select the ‘Details’ button from the plan card.

  • Drug costs est.: This is the estimated out-of-pocket costs for drugs you've listed in the shopping session. Drug cost estimates calculate estimated costs from the effective month of the plan through December of the plan year.

The ‘Your drug costs’ section displays costs for drugs included within the shopping session. Prices displayed reflect the cost of filling a respective medication at the pharmacy selected within the shopping session, or the default pharmacy if no pharmacy was selected.

Notable items housed within the ‘Your drug costs’ section include:

  • Drug tiers

  • Indicators for prior authorization, step therapy, and quantity limits

  • Phased cost breakdowns before, during, and after the coverage gap (aka “donut hole”). Learn more about the coverage gap here.

As you scroll, you will notice a much more granular view of the plan’s benefits.


Enrollment


Frequently asked questions

How is consent managed within HealthSherpa for Medicare?

You will follow the same CMS guidelines you do today regarding documented Permission to Contact (PTC) and Scope of Appointment (SOA).

Where does the plan, provider, pharmacy, and drug data come from?

This comes from our integration with Connecture.

Do you have a Third Party Marketing Organization (TPMO) disclaimer?

Not at this time. Consider leveraging this free site to create TPMO disclaimers by zip code and county.


Questions? Contact support

Call (855) 521-4984 or email medicare-agents@healthsherpa.com with questions.


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