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.
Select a plan.
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.
Begin to use your prescription drug card.
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.
When does the plan begin?
Between September 17 and September 30, 2012
October 15, 2012
December 7, 2012
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 »
Important Changes to Remember