Expected Changes in Medicare Part D for 2012?

Medicare Part D Plan in 2012?

Based on cost and benefit data from the Centers for Medicare and Medicaid Services (CMS)

What changes can you expect for next year?

In general, most of next year's 2012 Part D standard plan benefit parameters are based on an increase of 7.5% over the same 2012 parameters. In other words, plan variables like the initial deductible or doughnut hole limits will increase about 7.5%.

Please note that these parameters do not include information on the average monthly Part D plan premium.

Key 2012 Part D plan parameters affected by this increase include:

1. the initial annual deductible - increasing from $270 in 2012 to $290 in 2012 (please note that some, if not most, 2012 Medicare Part D plans do not have an initial deductible and provide first dollar coverage),

2. the initial coverage limit - also know as the portion of coverage shared by the beneficiary and the insurance carrier before the doughnut hole or coverage gap, increases from $2,500 to $2,700,

3. the annual out-of-pocket threshold - or the total amount that beneficiaries could personally spend before exiting the doughnut hole is increasing from $4,025 to $4,325,

4. the Retiree Drug Subsidy (RDS) cost threshold and cost limit for 2012 qualified retiree prescription drug plans will increase by 7.5% from their current 2012 values of $270 and $5,625 to $290 and $6,050 respectively.

How will changes in 2012 compare to the changes we experienced in 2012?

The 7.5% increase in 2012 Part D plan values can be compared to a 4.6% increase in 2012 Part D plan parameters from 2012.

What do all these numbers mean?

Your Medicare Part D plan will change each year. Each year CMS releases a Defined Standard Benefit or standard Medicare Part D plan as a model for the next year's Medicare Part D plans.

As an example, next year if you have a Medicare Part D plan that exactly follows this 2012 CMS plan, you will notice an increase in your initial deductible to $290 from the current 2012 value of $270. Also, people with high prescription drug costs can begin to prepare for increases in total out of pocket expense that must be spent before entering the catastrophic coverage portion of their Part D plan.

True Out Of Pocket expenses will increase in 2012 to $4,325 from the current 2012 value of $4,025. Some 2012 Medicare Part D plans may be exactly the same as the standard CMS plan. Other 2012 Medicare Part D plans may provide some doughnut hole (or coverage gap) coverage and/or no initial deductible or even a variation of the initial deductible.

We will help you get an idea of your potential 2012 prescription drug expenses.

Please take note: "Individuals enrolled in an MA plan may not concurrently enroll in a PDP except for individuals enrolled in a Medicare MSA plan or individuals enrolled in a PFFS plan that does not offer Medicare prescription drug coverage. An individual enrolled in an MA PFFS plan that does not include a Part D benefit may enroll in a PDP, even if under the same MA contract the organization offers another PFFS plan that includes a Part D benefit. " Chapter 2 " Medicare Advantage Enrollment and Disenrollment" of the CMS Medicare Managed Care Manual, Section 20 (2012).

We noted that enrollment in a stand-alone prescription drug plan (PDP) may affect the status of your current Medicare Advantage plan.

We caution that enrollment in a Medicare Advantage plan without prescription coverage may indicate to CMS that you no longer wish to have Medicare Part D coverage for the current year. It's important that you understand your options before enrolling in any Medicare health plan and consult a professional for assistance regarding Medicare rules and regulations.