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Part D Insurance
Humana Part D

Licensed Medicare Part D agents represent virtually every insurer in the United States. No one knows the rules and regulations of the Medicare industry better than the local insurance agent.

Medicare Insurance Plans

Medicare Part D Description and Enrollment

donut hole for medicare part d

Medicare Part D 2013 and Enrollment Period

When the Medicare Prescription Drug, Improvement and Modernization Act of 2003 was enacted, it was intended to give Medicare unprecedented access to prescription drugs through a prescription drug benefit called Medicare Part D. 

Whether they even needed prescription drugs wasn’t even part of the consideration – all Medicare and Medicaid recipients were eligible under a Medicare Part D plan.

Medicare Part D description indicates that prescription drugs could be accessed from either of two sources:

(1) Prescription Drug Plan (PDP) or

(2) managed healthcare plan with prescription drug benefit, which are also known as Medicare Advantage plans.

The Center for Medicare and Medicaid Services (CMS), in overseeing the Medicare Part D program, has divided the country into 34 regions. In each region, Medicare beneficiaries must have a choice of at least two Part D plans and one stand-alone PDP. The CMS requires for all medically necessary drugs to be made available to seniors.

Throughout all Medicare Part D plans, there are standard benefits that vary from year to year. Standard benefits are the basic benefits that all Part D plan providers must offer, although they can vary their plan features around these basic benefits. For standard Part D coverage recipients pay monthly a premium ($35/month in 2006), an annual deductible and co-insurance for costs over the deductible and up to the initial limit.

When the initial Part D coverage limit ($2,250 in 2006) is reached, the Part D beneficiary must pay for all drug costs until his or her out-of-pocket expenses total $3,600, this would be equal to $5,100 in total expenditure. The gap between the initial coverage limit of $2,250 and $5,100 is called the doughnut hole or coverage gap (when the Part D beneficiary must spend for their own medicine).  Beyond the doughnut hole, the Part D recipient then picks up 95% of future costs.

Medicare Part D 2013

Every year, there are increases in the minimum amounts of Medicare Part D. The year 2013 will be no different. From $275 in 2013, the initial deductible rate will be $295 in 2013. From $2,510 in 2013, the initial coverage limit becomes $2,700 in 2013. From $4,050 in 2013, the threshold for out-of-pocket expenses becomes $4,350 in 2013.

There is also an increase in the minimum cost sharing in the 2013 Part D’s Catastrophic Coverage Portion. From $2.25 for generic drugs and $5.60 for prescription drugs in 2013, the cost sharing is increased to $2.40 for generic drugs and $6.00 for prescription drugs in 2013.

There is also an increase in the maximum co-payments for Medicare/Medicaid recipients who spend below the out-of-pocket threshold. From $2.25 for generic drugs and $5.60 for prescription drugs in 2013, the amount is increased to $2.40 for generics and $6.00 prescription drugs in 2013. 

Part D Enrollment Period

Keep yourself informed of the latest Medicare Part D plans because aside from minimum amounts, formularies (the list of drugs covered by the Part D plan) also change. You can obtain information on the 2013 Part D plans beginning on October 1, 2013. You can elect a new Part D plan from November 15, 2013 to December 31, 2013. Check whether your employer will allow you to stay on your work Medicare plan if you are thinking of retiring.

JM-07-2013