A few notes to help with the understanding of the 2013 Medicare Part D Plan chart above.
- Plan Name: This is the official plan name from CMS
- Deductible: This is the $325 deductible that was presented in the CMS Standard Plan. Many provider’s plans do not have a deductible, however the premium may be higher.
- Qualifies for $0 Premium with Full Low-Income Subsidy?: If Yes is in the field, then you would pay a $0 premium if you have a Full Low-Income Subsidy. If No is in the field, then you would be responsible for the difference between what the state provides as the Full Low-Income Subsidy and the actual cost of the plan even if you have a Full Low-Income Subsidy.
- Coverage Gap the Donut Hole: In the CMS Standard Plan, the beneficiary must pay the next $3763.75 in drug costs (the Donut Hole).
The Healthcare Reform provides that for Plan Year 2013, ALL formulary generics will have at least a 21% discount and ALL brand drugs will have at least a 52.5% discount in the coverage gap. The Gap Coverage Types discussed in this section are in addition to the Healthcare Reform mandated discounts. In our chart, you will see one of the following:
- No Gap Coverage: you must pay the $3763.75;
- Few Generics: less than 10% of formulary generics are covered, but you must pay for Brand Drugs up to $3763.75;
- Some Generics: 10% to 65% of formulary generics are covered, but you must pay for Brand Drugs up to $3763.75;
- Many Generics: 65% to 100% of formulary generics are covered, but you must pay for Brand Drugs up to $3763.75;
- All Generics : All formulary Generics are covered, but you must pay for Brand Drugs up to $3763.75;
- Many Generics & Some Brands: These Medicare prescription drug plans cover 65% to 100% of formulary generics and a some (10% to 65%) of Brand drugs on the plan’s formulary.
- Some Generics & Some Brands: These Medicare prescription drug plans cover 10% to 65% of Generic and Brand drugs on the plan’s formulary. (Search Tip: If you would like to reduce the plans shown to just plans with a certain type of gap coverage, select this type of coverage in the "Type of Gap Coverage" field.)
- Benefit Type: Basic means that this plan follows the standard CMS plan. Enhanced means that this plan has features above and beyond the standard CMS plan.
- Plan ID: This is the unique id for this particular plan.
(Chart Source: Centers for Medicare and Medicaid file 2013LandscapeSource file PDP.xls)
Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, we cannot guarantee the accuracy of this information. Through the application process we will provide you with the most up-to-the-minute information/pricing.
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