Monday, January 10, 2011

Medicare Part D

Changes to Medicare Part D Prescription Drug plans for 2011

Question: Are there changes in the 2011 Medicare Prescription Drug Plans?

Answer: These are the changes in the 2011 Medicare Prescription Drug Plans

 Initial coverage phase has been increased from $2830 to $2840.
The initial coverage phase is the first phase of Part D Prescription Drug plans. In this phase, you pay your deductible, if you have one, and then pay copays until your total drug costs reach $2840 for 2011. Your total drug costs are made up of your deductible, the copays you pay and the amount your insurance company pays toward your drug costs. You can estimate when you will exit the initial phase by knowing the total retail cost of the drugs you take. Once you exit the initial coverage phase, you enter the Coverage Gap or Donut Hole.

 Help in the Gap.
Healthcare reform gave help in the form of a $250 rebate for people who entered the coverage gap in 2010. For 2011, people who enter The Gap will receive up to 50% off the retail cost of their medications. If you entered The Gap in the last quarter of 2010, you should receive your $250 in the first quarter of 2011.

 No increase in threshold for Catastrophic Coverage Phase.
Once your total out of pocket expense for your drugs reaches $4550, you enter the Catastrophic Phase. This is the same threshold as 2010. In this phase you have significantly lowered copays, $2.50, $6.30 or 5% of the retail cost of the drug, depending on the medication classification. You remain in the Catastrophic Phase through the end of the plan year which starts over every January.

 Reduction in plans offered and companies offering plans.
In an effort to simplify Part D Prescription Drug plans, it was mandated that companies offering these plans could offer no more than 2 choices of plans. As a result, many plans were discontinued for 2011 and many people are getting used to a new plan. Most insurance companies added deductibles to at least one of their plans. I have seen some confusion at the pharmacy with the deductibles in my clients’ situations so be alert the first few times you fill your prescriptions to make sure you are not over paying.