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Medicare Part D 2013

You may be eligible for assistance in paying for your prescription drug plan. To find out what the income guidelines are or to fill out an application for assistance, please call 1-800-MEDICARE (1-800-633-4227) or fill out an online application at www.socialsecurity.com or contact your State Health Insurance Assistance Program (SHIP). You can speak with a SHIP counselor who will help you apply. After you apply for assistance, you will receive a letter in the mail letting you know whether or not you qualify and what steps to take next. Please SAVE THAT LETTER.

Find a Medicare Prescription Drug Plan.
Medicare offers a service to help you find a Medicare Prescription Drug Plan. Their Medicare Plan Finder under My Medicare Tools at www.medicare.govwill help you access the drug plans available in your area. You can also call 1-800-MEDICARE (1-800-633-4227).

Select a plan.

  • How high is the annual deductible?
  • Can I use the plan at the pharmacy of my choice?
  • Are lower co-payments available only at pharmacies that I’m directed to use?
  • How high is the annual premium?
  • Does the plan cover all my medications?
  • If a medication I take isn’t covered, does it cover an alternative that will work for me? (Discuss with your doctor or pharmacist.)
  • Does the plan require prior authorizations for my medications -- for example, step therapies?
  • How much will I pay at the pharmacy (co-payments or coinsurance) for the specific medications I need?
Each of these questions is important, some more than others depending on factors such as the medications you take and how you want to obtain your prescriptions.

 

Contact the Medicare Part D Plan for enrollment material.

Complete the enrollment package and mail.
If you are eligible for additional help, you must still send in an application to enroll in the plan that you choose.

Begin to use your prescription drug card.
Once you have received your prescription drug identification card, please remember to present the card to your pharmacy when having a prescription filled. Contact the plan with any questions about your coverage. Your pharmacist is always available to assist you in changing drugs or finding generic alternatives. If you have any questions or concerns about your medications, ask your pharmacist.

The 2013 Medicare Part D Prescription Drug Plan Year

Open Enrollment begins October 15, 2012 and ends December 7, 2012

Last year’s open enrollment date change was a success, allowing Part D Plans and Medicare to process new enrollments and get welcome kits and membership cards out to members prior to the January 1st plan effective date.

5 Star Plan Special Enrollment Period

In 2012 CMS introduced a new Special Enrollment Period (SEP). The 5 Star Plan SEP will continue in 2013. Starting December 8, 2012 you can switch to a 5 star Medicare Prescription Drug Plan at any time during the year. This enrollment period will allow members to change plans once at any time during the year as long as you are switching to a 5 star rated plan. Plan ratings are displayed on the Medicare website at www.medicare.gov.

If you choose to switch plans and enroll in a 5 star plan after December 7, 2012, the effective date for your new plan will be the first of the month following the month the enrollment request is received.

Although this change may seem positive on the surface, just because a plan is rated 5 stars does not mean it is necessarily the best plan for their circumstances. You will still need to ensure that the plan is affordable and that all of your medications are included in the plan’s formulary.

2013 Special Enrollment Period (SEP) to Leave a Consistently Low Rated Medicare Drug or Health Plan

To promote high Medicare Part D and Medicare Advantage plan quality, in 2013, The Centers for Medicare and Medicaid Services (CMS) will alert plan members if their Medicare Part D drug plan or Medicare Advantage health plan has failed for three straight years to achieve at least a 3-star quality rating and offer a Special Enrollment Period (SEP), if desired, that will allow the member to move to a higher quality plan.

If you are satisfied with your 2012 coverage, do nothing.
You will be automatically re–enrolled in the plan you were in if you do not elect to enroll in a different Medicare D Plan for 2013.

When does the plan begin?
Medicare (and eligible Medicaid) participants may enroll in the plan beginning October15th and the benefits will start January 1, 2013.

Key Dates

Between September 17 and September 30, 2012
Medicare began mailing the 2013 Medicare & You Handbook that includes valuable information about all areas of Medicare. Section 6 of the Handbook, pages 81–94, is all about the 2013 Medicare Part D Prescription Drug Plan.

October 15, 2012
Marks the beginning of the open enrollment period.  This is the first day to enroll in a plan for 2013.

December 7, 2012
Last day of the annual enrollment period, this is the last day to make an enrollment change (with the exception of the 5 star plan change and special enrollment period to leave a low rated plan).

December 8, 2012

Marks the beginning of the 5 Star Plan special enrollment period.

Medicare Part D 2013 Plan Overview

Monthly Premium:Costs vary by plan.

Initial Deductible:You pay an annual deductible up to $325.00 (an increase from $320.00 in 2012, but plan deductibles vary).

Initial Coverage Limit:The initial coverage limit for 2013 is $2,970.00, which is the combined amount of prescription expenses paid by the plan and the co-payments (an increase from $2,930.00 in 2012).

Enter the Coverage Gap (a.k.a. the Donut Hole):After the Initial Coverage Limit has been met, coverage stops and you pay all your prescription costs until your total prescription expenses reach $6,733.75. In 2012, Part D enrollees will receive a 52.5% discount on the total cost of brand name drugs and a 21% discount on the total cost for generics drugs while in the donut hole until you reach the end of the coverage gap.**

Once expenses reach a total combined amount of $6,733.75 (what the plan has paid and what you have paid, including the donut hole), catastrophic coverage begins and your Part D plan pays 95% of covered prescription costs.

**You may be able to choose a plan that will assist you with some of your out-of-pocket costs. Some plans offer additional coverage during the coverage gap, so please review the plans to determine the best plan for you.

Qualifying for additional help

If you have limited income or few assets, you may be able to get additional help from Medicare. You may be eligible for reduced co-payments, lower or no premiums, and a zero deductible. Please review Section 7, pages 95-102 of your Medicare & You Handbook for more details or ask your pharmacist for more information.

You may also contact the Social Security Administration (SSA) or Medicare directly.

Social Security Administration >>
1-800-772-1213

Medicare >>
1-800-MEDICARE (633-4227)

Important Changes to Remember

  • Open Enrollment Period is October 15, 2012 thru December 7, 2012
  • 5 Star Plan Special Enrollment Period begins December 8, 2012 allowing members to make a one-time switch to a 5 star rated plan at any time during the year (after the annual enrollment period has ended).
  • Part D enrollees will receive a 52.5% discount on the total cost of brand name drugs and a 21% discount on the total cost for generics drugs while in the donut hole until they reach the end of the coverage gap.
  • Special Enrollment Period to Leave a Consistently Low Rated Medicare Plan allowing members to move to a higher rated plan if their current plan has failed for three consecutive years to achieve at least a 3-star rating .
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