Seniors Have More Reasons to Switch Medicare
Prescription Drug Plans, Consultant Says
Editor’s Note: The window is open at Medicare for
seniors to change the way they receive benefits in 2014 (open through
Dec. 7). Most of the attention is focused on the Part D prescription
drug plans, which tend to change – some drastically – from year to year.
Below is an analysis provided by Allsup, a company that markets health
plan consulting advice.
Medicare Open Enrollment Oct. 15 thru Dec. 7
people with Medicare can choose plans for 2014
Nov. 4, 2013―A number of changes affecting
prescription drug Part D plans signal important reasons for seniors and
people with disabilities relying on Medicare to review coverage during
the annual open enrollment, according to Allsup, a nationwide provider
of Medicare plan selection services.
“This year includes some significant changes in
prescription drug Part D plans, so it’s important that Medicare
participants examine their options closely,” said Paula Muschler,
operations manager of the Allsup Medicare Advisor, a Medicare
plan selection service offering personalized help that includes
customized research and enrollment assistance for Part D plans and other
Medicare plan options.
Among the changes are plan costs, plan drug
coverage changes, changes to the donut hole, and new plan options and
In addition to changes in existing plans, more than
200 new Part D plans are being offered this year, Kaiser Family
Foundation1 reported, while nearly 50 plans left the market.
“Anytime a Part D plan closes down, Medicare
participants who were in that plan have a valuable opportunity and
should take advantage of this change to study their options. They may
have some great new plans to choose from for 2014,” Muschler said.
For example, the average number of stand-alone Part
D plans increased for 2014, with an average 35 plans now available to
beneficiaries, according to Kaiser.
“Thirty-five plans is a lot of information to sort
through. Part D plans also can change from year-to-year, in terms of
their drug formularies and other provisions—so it can get complicated
pretty quickly,” Muschler said.
The following are significant changes for
prescription drug coverage in 2014.
Changes in Medicare Part D Plans, Premiums:
• The Part D base beneficiary premium is $32.42
in 2014, which is close to a 4 percent increase from $31.17 in 2013.
• As cited earlier, 212 new Part D plans enter
the market and 46 plans leave the market.
• More insurers are featuring Part D plans with
preferred pharmacy networks, where the plan provides cost discounts for
using that specific pharmacy chain.
• New for 2014 is the small-supply drug option.
Medicare Part D participants typically received coverage for a one-month
supply of medication. Starting in 2014, though, individuals can ask for
less than a one-month supply for most types of drugs. “This may seem
like a small change, but it’s a valuable option for patients and their
doctors who want to conduct a shorter trial on a medication, rather than
having to purchase a month’s worth of medication,” Muschler explained.
Donut Hole Changes
There will be changes to the prescription drug
“donut hole.” The donut hole is the gap of coverage when the beneficiary
pays a greater portion of their drug expenses. The initial coverage
limit will be $2,850 (vs. $2,970 in 2013), and the out-of-pocket
threshold is $4,550 (vs. $4,750 in 2013).
Medicare Part D participants who reach the donut
hole will pay less for their generic prescriptions next year. Their
share of brand-name drug costs stays at 47.5 percent, but they will pay
less for generic drugs at 72 percent in 2014 (vs. 79 percent in 2013).
None of the standalone Part D plans offered in 2014
will offer full coverage during the donut hole.
The impact of these changes will vary depending on
the individual—but the donut hole is one example. Overall, it will be
$80 smaller in 2014, but because the initial coverage limit ends at
$2,850 vs. $2,970, more people could end up in the coverage gap sooner.
Nearly 2.8 million people reached the donut hole in
the first nine months of 2013, an increase of nearly 22 percent compared
to last year. About 2.3 million people reached the donut hole during the
first nine months of 2012, according to the Centers for Medicare &
Reason to Switch Part D Plans
For those who aren’t certain whether they should
change their Part D coverage, the following are some reasons to
• Part D plan costs change. Costs for
prescription drug coverage include the premium, deductible, and co-pays
or coinsurance. Medicare participants may be able to reduce costs by
comparing their options and switching to a new plan.
• Drug formularies (drugs covered by the
plan) change. Beneficiaries should ensure their necessary
medications are still covered. In addition, they may find coverage at a
lower cost by comparing plans.
• Part D plans leave and enter the market.
Participants may find they have to choose a new plan because their
current plan will be closing. New options also may be offered that
provide coverage and cost that are a better match for someone’s health
and financial resources.
• Individual health changes. Someone who
has experienced an injury or new condition may find their current plan
is more costly than an alternative offered in their area.
• Preferred pharmacy plans expand. There
may be some additional cost savings by taking advantage of discounts
offered through a preferred pharmacy plan that’s now available in
“Medicare participants still have several weeks to
review their Part D plans and make a selection for 2014, and they may
find significant cost and health benefits by seeking help from a
Medicare specialist like Allsup,” Muschler added.
Medicare beneficiaries choosing to switch plans
have now through Dec. 7 to complete Medicare plan selection and
enrollment for insurance coverage that takes effect Jan. 1, 2014.
1 – October 2013. Kaiser Family
Foundation. “Medicare Part D: A First Look at Plan Offerings in 2014.”
Allsup describes itself: Allsup is a
nationwide provider of Social Security disability, veteran’s disability
appeal, Medicare and Medicare Secondary Payer compliance services for
individuals, employers and insurance carriers. Allsup professionals
deliver specialized services supporting people with disabilities and
seniors so they may lead lives that are as financially secure and as
healthy as possible. Founded in 1984, the company is based in
Belleville, Ill., near St. Louis. For more information, go to
http://www.Allsup.com or visit
Allsup on Facebook at
For an evaluation of Medicare
options, call an Allsup Medicare Advisor specialist at (866) 521-7655 or
visit Medicare.Allsup.com to learn more about the service.
The Allsup Medicare Advisor also has features that
help financial advisors guide their clients to the Medicare plans that
match their specific lifestyles and healthcare needs. Employers also use
Allsup Medicare Advisor for their employees who are retiring and
transitioning to Medicare.
For more information, go to
FinancialAdvisor.Allsup.com, or call (888) 220-9678.
Medicare Open Enrollment 2014 - Related
Window for making changes to your Medicare
coverage opens October 15, closes December 7
Oct. 14, 2013 -
With the Medicare’s open enrollment period opening on Tuesday,
this is a good summary of the basics about Medicare health
insurance – what is available to keep you healthy with plans
that meet your needs. It is by Pamela Yip, a business writer for
the Dallas Morning News, who regularly covers Medicare. Click to
Dallas Morning News
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