Find Affordable Medicare Insurance
2013 Medicare Part D Prescription Drug Plan (PDP) Guide
Can you believe it? 2013 is almost here! It feels like just yesterday when we wrote our article all about Medicare Part D in 2012. Another year has elapsed and it's time to gear up for the 2013 Medicare season. Welcome to eHealth Medicare's 2013 Guide to Medicare Part D Prescription Drug Plans (PDPs). What is Medicare Part D and what are Prescription Drug Plans, you ask? Offered via private insurance companies, PDPs provide Medicare Part D drug coverage that are in addition to your Original Medicare and/or your Medicare Supplement insurance. Once you're enrolled in Original Medicare, you are eligible to enroll in PDP coverage under Medicare Part D.
Much like last year's guide, this article provides an overview of some key highlights and changes to Medicare Part D in 2013. Before reading today's article, we recommend first checking out our Medicare Part D Prescription Drug Coverage overview. Also, if you are interested in learning about 2013 Medicare Advantage (Medicare Part C) highlights, you may also wish to check out our 2013 Medicare Advantage Guide. Without further ado, let's jump into our Medicare Part D Guide for 2013.
Sections of Our 2013 Medicare Part D Guide:
Annual Enrollment Period(AEP) is an important time for Medicare. It's the period each year when all Medicare beneficiaries are able to join, switch, or drop their PDP or Medicare Advantage Plan. Looking back to 2011, Annual Enrollment Period (AEP) spanned November 15, 2010 to December 31, 2010 (or 47 days). As a result of the Affordable Care Act (Health Care Reform), the dates of AEP have since changed.
Specifically, AEP has expanded and shifted earlier in the year. It spanned October 15, 2011 to December 7, 2011 (or 54 days) for 2012 Medicare plans. Looking forward to the 2013 Medicare year, AEP is currently scheduled to span October 15, 2012 to December 7, 2012. Moreover, it is expected that AEP will span these same dates going forward, each year. If you're interested in joining, switching, or dropping your Prescription Drug Coverage, it's important to be aware of the Annual Enrollment Period dates.
In 2012, a new Special Enrollment Period (SEP) was introduced for 5-star plans. The goal: Get Medicare beneficiaries enrolled in high quality Prescription Drug Plans. It is anticipated that the SEP for 5-star plans will continue in 2013. It is anticipated that anytime during 2013, you will be able to switch from your current plan into a 5-star rated PDP. The SEP also applies to Medicare Advantage (MA) plans as well. There are other SEPs available for beneficiaries with qualifying events.
Have you heard of the Medicare Part D Donut Hole (also known as the coverage gap)? PDPs that have a donut hole work like this:
- 1. Each year, the first $2,840 in covered prescription drug costs are paid for by the PDP and your copayment/coinsurance.
- 2. After that first $2,840 you are in the "donut hole" and must cover costs out-of-pocket. You will remain in that donut hole (or overage gap) until your total out-of-pocket expenses on prescription drugs reaches $4,550.
- 3. At that time, Medicare Part D's catastrophic limit kicks in and Medicare beings covering your drug costs again.
Due to the Affordable Care Act (Health Care Reform), the donut hole will shrink again in 2013. Specifically, while in the gap, you will get a 52.5% discount on brand name drugs and 21% discount on generic drugs. In other words: While in the coverage gap, you will pay 47.5% the price of brand name drugs and 79% the price of generic drugs. The donut hole coverage has increased as compared to the 2012 Medicare year. In 2012, by comparison, the donut hole discount was 50% on brand name drugs and 14% on generic drugs. In other words: While in the coverage gap, you paid 50% the price of brand name drugs and 86% the price of generic drugs, for the 2012 Medicare year.
Check out our 2012 Part D Guide for an overview of how the donut hole will continue to shrink each year, through 2020. The table in that guide outlines how much you will pay each year while in the gap. Also, we have included a table below that shows the discount you will receive each year through 2020, another way of viewing the same data.
|Brand-name drug discount in coverage gap||Generic drug discount in coverage gap|
|Source: Medicare.gov - Closing the Coverage Gap - CMS Product No. 11493
You may call 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day/7 days a week, to inquire if a copy of this report may be mailed to you.
According to the Department of Health and Human Services (HHS), Medicare PDP premiums are likely to stay constant in 2013. In 2012, the average PDP premium was projected to come in at $30. The actual number averaged $29.67. In 2013, it is again forecasted that PDP premiums will average $30. According to HHS Secretary Katherine Sebelius, "Premiums are holding steady and, thanks to the health care law, millions of people with Medicare are saving an average of $600 each year on their prescription drugs." It is expected that the Affordable Care Act will continue to save Americans money in 2013 and beyond.
PlanPrescriber performed a 2012 Choice Impact Study, analyzing more than 100,000 user sessions from PlanPrescriber.com during the 2012 AEP (October 15, 2011 through December 7, 2011). The study finds that Medicare beneficiaries could benefit by comparing Medicare PDPs during AEP to find if a more cost-effective plan is available to meet their needs.
Specifically, the study highlights that only 5% of customers were in the Prescription Drug Plan with the lowest total out-of-pocket costs available to them. Also, the study suggests that the average user who switched to the PDP with the lowest possible total out-of-pocket costs in 2012 could have saved $654 over their existing PDP. Another interesting statistic from the study: In the 10 largest states in the country, the average PDP covered about 67 percent of all drugs approved by Medicare. The minimum number of drugs covered by a PDP (in any market) was 49 percent.
This study highlights the value in researching and comparing PDP plans. As you research your 2013 Medicare Part D options, it is likely that plan comparison (via tools such as those offered by PlanPrescriber, eHealth Medicare, or Medicare.gov) could help find the most cost-effective plan to meet your needs.
Source: 2012 Choice Impact Study
In summary, the 2013 Medicare year is upon us. There are many key points to be aware of as you investigate Medicare Part D in 2013. In particular, we suggest taking note of the Annual Enrollment Period (AEP) dates, the Special Enrollment Period for 5-star plans, changes in the Part D Donut Hole, trends in Prescription Drug Plan premiums, and opportunities to compare plans to reduce out-of-pocket expenses. Whether it's 2013 or any other year, eHealth Medicare is here to help you find the right Medicare Prescription Drug Plan based on your needs. Also, you may research your Medicare options by visiting www.medicare.gov, calling 1-800-Medicare (TTY 1-877-486-2048), 24 hours a day/7 days a week, or visiting your local Medicaid office. Thanks for reading our guide!