CMS Medicare Prescription Plans Remain Constant – The Donut Hole is Filled

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The Centers for Medicare & Medicaid Services (CMS) recently announced that the average basic premiums for Medicare prescription drug plans are projected to remain constant in 2013.  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.  Savings will increase over time until 2020, when the coverage gap will be closed.  

“Premiums are holding steady and, thanks to the health care law, millions of people with Medicare are saving an average of over $629 each year on their prescription drugs,” said Health and Human Services Secretary (HHS) Secretary Kathleen Sebelius.   

“Millions of people with Medicare have been paying less for prescription drugs thanks to the healthcare law,” said Marilyn Tavenner, the head of the Centers for Medicare and Medicaid Services.  “Seniors and people with disabilities have already saved close to $4 billion. In 2020, the doughnut hole will be closed thanks to the Affordable Care Act.”

In Maryland, the Baltimore Sun reported that seniors have saved $56.5 million on prescription drug costs because of a provision under health care reform that has eased the Medicare donut hole. 

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. 

Because of the Affordable Care Act, out-of-pocket savings on medications for people with Medicare continue to grow.  Last month, CMS announced that more than 5.2 million people with Medicare have saved over $3.9 billion on prescription drugs in the Medicare Part D donut hole since the law was enacted.  In the first half of 2012, over 1 million people with Medicare saved a total of $687 million on prescription drugs, averaging $629 per person this year. 

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 coverage gap 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.

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