Q1Medicare.com Provides Seniors with a Preview to their 2013 Medicare Part D Prescription Drug Plan Coverage

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Based on recently released Medicare information, seniors can expect a smaller increase in their 2013 Medicare Part D prescription drug plan parameters as compared to the increases they saw last year. Most Medicare Part D plan parameters, such as the initial deductible or out-of-pocket expense limit, are proposed to increase by less than 2% in 2013, as compared to the roughly 3.2% increase in the same values in 2012. To help the Medicare community better understand the impact of these proposed 2013 changes, Q1Medicare.com has released their 2013 PDP-Planner, a simple to use online tool that illustrates how Medicare prescription drug costs change throughout the year and the different phases of prescription drug coverage.

Our PDP-Planner is designed to help Medicare Part D beneficiaries visualize annual prescription spending during the various phases of their Part D plan coverage

Seniors and other Medicare beneficiaries can plan on increases in their 2013 Medicare Part D prescription drug plan coverage parameters, but the proposed plan changes are less than the changes experienced this year. Based on the recently released information from the Centers for Medicare and Medicaid Services (CMS), 2013 Medicare Part D plan parameters such as the initial deductible, initial coverage limit and out-of-pocket threshold limits will increase by less than 2% as compared to the roughly 3.2 % increase in 2012 plan parameters.

An online summary comparing the changes in CMS Medicare Part D defined standard benefit parameters from 2006 through 2013 is available at Q1Medicare.com/2013. Here is an overview of some of the proposed changes in the 2013 Medicare Part D plan parameters:

  •     Initial Deductible (the amount a senior pays before their Medicare Part D prescription drug plan begins to pay) - The 2013 initial annual deductible will increase $5 to $325 from the current 2012 standard value of $320. As a note, over half of the 2012 stand-alone Medicare Part D plans have an initial deductible. An overview of the 2012 Medicare Part D prescription drug plan landscape can be found at: PDP-Facts.com/2012.
  •     Initial Coverage Limit (the negotiated retail dollar value of a senior’s prescription drug purchases used to determine when a person enters into the 2013 Donut Hole or coverage gap phase of their Medicare Part D plan) – Medicare beneficiaries will enter the 2013 Donut Hole or coverage gap when the total negotiated retail cost of their prescription drug purchases reaches the initial coverage limit of $2,970, a $40 increase over the 2012 initial coverage limit of $2,930.
  •     True Out-of-Pocket Costs (the actual dollar figure a person spends to get out of their Donut Hole or coverage gap, excluding monthly premiums) - The 2013 out-of-pocket threshold (or TrOOP) will increase by $50 to $4,750 from the current 2012 value of $4,700.

These 2013 Medicare Part D plan parameters are still tentative and the actual or final parameters will be released by CMS in April. An example of the 2013 Medicare prescription drug plan phases for someone with $800 per month retail medication expense can be found at PDP-Planner.com/2013/ex1.

Next year, seniors will also find that the 2013 Donut Hole discount will increase for both generic and brand-name drugs. People who reach their 2013 Donut Hole will receive a 21% discount on generic medications and a 52.5% discount on brand-name drugs while in the coverage gap. However, the full retail cost of medications purchased in the Donut Hole will still count toward meeting a person’s 2013 total out-of-pocket expense limit of $4,750.

To help seniors and other Medicare beneficiaries better understand the impact of these proposed 2013 changes in the Medicare Part D plan benefit parameters, Q1Medicare.com released their online 2013 PDP-Planner tool. PDP-Planner allows users to visualize how they could potentially move through their Medicare Part D plan from initial deductible (if applicable) into the initial coverage phase, through their coverage gap or Donut Hole, and maybe even into the catastrophic coverage portion of their Medicare Part D plan.

“We are still finding that many people have difficulty understanding the coverage provided by their Medicare Part D prescription drug plan,” noted Dr. Susan Johnson, technical director of the Q1Medicare.com website. “Our PDP-Planner is designed to help Medicare Part D beneficiaries visualize annual prescription spending during the various phases of their Part D plan coverage and, although many Medicare Part D plans offer a variation of deductibles and cost-sharing options, we find that this defined standard benefit acts as a good benchmark for planning upcoming Medicare Part D expenses.”

Users of PDP-Planner can enter estimated retail prescription costs based on their current drug spending and, if desired, change the Medicare Part D plan initial deductible, to get an idea of how they will move through the phases of their Medicare Part D plan coverage. A person’s total estimated drug costs, including the annual Donut Hole discount for various mixes of brand-name and generic medication purchases are then displayed in a chart format at the end of the PDP-Planner results table.

The Q1Medicare.com PDP-Planner is available at no cost and users have the option to have a copy of their PDP-Planner results sent directly to them via eMail. The 2013 PDP-Planner can be found directly at PDP-Planner.com/2013 and, like all other Q1Medicare.com tools, can be accessed on PC, smartphone, or tablet platforms.

About the Q1Medicare.com Website
Q1Medicare.com is one of the largest independent online resources for Medicare Part D prescription drug plan and Medicare Advantage plan information. Q1Medicare offers a comprehensive section of Frequently Asked Questions, online tools, and a free Medicare Part D Newsletter, all designed to help Medicare beneficiaries, caregivers, advocates, advisers, and insurance agents better understand the Medicare Part D and Medicare Advantage programs. Q1Medicare.com is operated by Q1Group LLC (Saint Augustine, Florida).

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Lynnea Christner

Susan Johnson MS-MIS, MBA, PhD
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