Kaiser Family Foundation: Medicare Part D: A First Look at Plan Offerings in 2014

Jack Hoadley, Juliette Cubanski, Elizabeth Hargrave and Laura Summer

The Centers for Medicare & Medicaid Services (CMS) recently released information about the Medicare Part D stand-alone prescription drug plans (PDPs) that will be available in 2014.1   Of the 36 million beneficiaries enrolled in Part D plans, about 63 percent (22.7 million) are in PDPs; the others are enrolled in Medicare Advantage drug plans.2   This Medicare Part D Spotlight provides an overview of the 2014 stand-alone PDP options and key changes from prior years.3.

Summary of Key Findings

Medicare Part D continues to be a marketplace with an array of competing plans offered at a wide range of premiums and benefit designs.

  • In 2014, Medicare beneficiaries will have a choice of 35 stand-alone PDPs, on average, up by four from 2013.  The average premium (weighted by enrollment) is expected to increase by 5 percent across all PDPs from 2013 to 2014 unless many new or current enrollees select lower-priced plans.  As in prior years, the average monthly premium for 2014 masks a significant amount of variation across plans.  Enrollees in two of the most popular PDPs will experience 50-percent premium increases if they stay in the same plans in 2014, while enrollees in three other popular PDPs will see lower premiums.
  • Beneficiaries receiving Low-Income Subsidies (LIS) will have access to a modestly higher number of plans for no monthly premium in 2014 compared to 2013, but some plans have lost their so-called “benchmark” status for 2014, which will require enrollees to switch plans to maintain the full value of their subsidies.
  • The majority of plans offered in 2014 will offer no gap coverage beyond that which is required by the Affordable Care Act (ACA) of 2010, which phases out the coverage gap by 2020.  Under current law, for 2014, manufacturer prices for brand-name drugs purchased in the gap will be discounted by 50 percent (with plans paying 2.5 percent and enrollees paying the other 47.5 percent), and plans will pay 28 percent of the cost for generic drugs in the gap (with enrollees paying 72 percent).
  • Notable trends for 2014 include a growing share of PDPs using preferred pharmacy networks and adopting more formulary cost-sharing tiers.  For example, a majority of PDPs now use preferred pharmacy networks where cost sharing is lower when enrollees use preferred pharmacies and higher outside the preferred network.  In 2006, few PDPs used this type of pharmacy network.

For complete report click here: http://kff.org/medicare/issue-brief/medicare-part-d-a-first-look-at-plan-offerings-in-2014/

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  • LAAAC is managed by St. Barnabas Senior Services; Funded, in part, by Archstone Foundation.
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