Does The Same Plan Continue On?

Q: I have been using Medicare Part D for all of this year and have saved money with the plan I chose. I am curious how I handle the new year of 2014? Does the same plan continue on? Do I have to sign up again? What do I need to do?

A: This is a question with multiple answers. Each year the insurance companies involved in Medicare Part D need to announce to their enrollees and the general public what their plans will consist of for the new year. This includes: do their plans continue, what their premiums are, what the formularies are, what are the deductibles and co-pays, etc.

Centers for Medicare and Medicaid (CMS) determines the minimum standards for these plans, but each company and plan can offer more than the minimum. CMS calls this minimum plan the “Standard Plan.” In 2014, the Standard Plan will have a $310 deductible, then the Initial Coverage period, which lasts until $2,850 total spent.

During this Initial Coverage your plan must pay at least 75 percent and you pay 25 percent of the medication cost. The “Coverage Gap” begins after those $2,850 have been spent by you and your insurance company (the donut hole). This ‘Coverage Gap” lasts up to $4,550 spent by you on your covered prescription medications. During the Coverage Gap you will pay 47.5 percent for brand name medication. You will pay 72 percent of the cost of generic medications. If you spend this much, you then hit the “Catastrophic” level of coverage, where your costs are 5 percent or less for your covered prescription medications. This “Standard Plan” works the same as previous years, the dollar amounts have been adjusted slightly (as they do every year).

This plan information is announced to everyone by Oct. 1 each year. That means the month of October begins a season of large amounts of mail. The insurance company that you are using is going to be sending information about their plan to you, and they also send out information to potential enrollees.

The Annual Open Enrollment Period is from Oct.15 to Dec. 7. This means that if you want to change your plan or add a Medicare Prescription Drug plan you do so during this period of time and the new plan you choose will start Jan. 1.

You can certainly stay with the plan you have if the information the insurance company sends to you looks to give you continued good coverage. If you want to research your options, you may do so after Oct. 1 by calling 1-800-medicare or going to www.medicare.gov. These tools are available 24 hours a day, but are especially useful during the Annual Open Enrollment Period. If you research your options, you may find that an alternate plan covers you more effectively.

In 2013 there were 27 Stand Alone Medicare Part D plans offered in our region. In 2014 there are 26 Stand Alone Medicare Part D plans offered in our region. The number of plans does not necessarily reflect much. The costs continue to change with the average price in premiums, etc. The Stand Alone Medicare Part D plans are only part of the options available, but that is what is now being offered in the Annual Open Enrollment period from Oct. 15 to Dec. 7.

In 2013 there were 24 Medicare Advantage Plans with 17 plans including Prescription Drug Coverage. In 2014 there are 21 Medicare Advantage Plans with 14 including Prescription Drug Coverage. None of these plans offer complete coverage through the coverage gap. A small number of the plans cover some generics and some name brand medications during this coverage gap

That is a lot of choices and the answers can be complicated. Take time to research your alternatives and decide which options work the best for you and your situation. Good luck and happy insurance season!