Tuesday, August 14, 2012

average Medicare Prescription Drug premiums remain steady for 2013

Average basic premiums for Medicare prescription drug plans are projected to remain constant in 2013, Health and Human Services Secretary (HHS) Kathleen Sebelius announced today. The average 2013 monthly premium for basic prescription drug coverage is expected to be $30. Average premiums for 2012 were projected to be $30 and ultimately averaged $29.67. At the same time, since the law was enacted, seniors and people with disabilities have saved $3.9 billion on prescription drugs as the Affordable Care Act began closing the “donut hole” coverage gap.

“Premiums are holding steady and, thanks to the health care law, millions of people with Medicare are saving an average of over $600 each year on their prescription drugs,” said Secretary Sebelius.

Today’s projection for the average premium for 2013 is based on bids submitted by drug and health plans for basic coverage during the 2013 benefit year, and calculated by the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary.

The upcoming annual enrollment period -- which begins Oct. 15 and ends Dec. 7, 2012 – allows people with Medicare, their families and their caregivers to choose their plans for next year by comparing their current coverage and quality ratings to other plan offerings. New benefit choices are effective Jan. 1, 2013.

As a result of the Affordable Care Act, coverage for both brand name and generic drugs in the coverage gap will continue to increase over time until 2020, when the donut hole will be fully closed. This year, people with Medicare received a 50 percent discount on covered brand name drugs and 14 percent coverage of generic drugs in the donut hole. In 2013, Medicare Part D’s coverage of brand name drugs will begin to increase, meaning that people with Medicare will receive a total of 52.5 percent off the cost of brand name drugs (a 50 percent discount and an additional 2.5 percent in coverage) and coverage for 21 percent of the cost of generic drugs in the donut hole.

For more information on how the Affordable Care Act closes the Medicare drug benefit donut hole, please visit: http://www.healthcare.gov/law/features/65-older/drug-discounts/index.html

Also the regional low-income premium subsidy amounts have been released for 2013. The low-income subsity (LIS) premium subsidy amount for WV is $36.57. This means beneficiaries who are eligible for LIS/Medicaid would need to enroll into a BASIC plan with a premium below this amount in order to not pay a premium (depending on their LIS level). There is a $2 de minimis, meaning that a prescription drug plan or Medicare Advantage plan with Prescription Drug Coverage may volunteer to waive the portion of the monthly adjusted basic beneficiary premium amount above the LIS benchmark for a subsidy eligible individual. Last year (for 2012), all plans agreed to do this. So technically, basic plan premiums in WV can be up to $38.57 as long as the plan agrees.


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