Wednesday, July 17, 2013

Did You Know: CMS defined Standard Benefit Plan changes



Here are the highlights for the CMS defined Standard Benefit Plan changes from this year to next. This “Standard Benefit Plan” is the minimum allowable plan to be offered.
  • Initial Deductible: will be decreased by $15 to $310 in 2014
  • Initial Coverage Limit: will decrease from $2,970 in 2013 to $2,850 in 2014
  • Out-of-Pocket Threshold: will decrease from $4,750 to $4,550 in 2014
  • Coverage Gap: begins once you reach your Medicare Part D plan’s initial coverage limit ($2,850 in 2014) and ends when you spend a total of $4,550 in 2014.
In 2014, Part D enrollees will continue to receive a 52.5% discount on the total cost of their brand-name drugs while in the coverage gap.  The 50% discount paid by the brand-name drug manufacturer will still apply to getting out of the donut hole; however the additional 2.5% paid by your Medicare Part D plan will not count toward your TrOOP. Enrollees will pay a maximum of 72% co-pay on generic drugs while in the coverage gap.
  • Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit**: will increase to greater of 5% or $2.55 for generic or preferred drug that is a multi-source drug and the greater of 5% or $6.35 for all other drugs in 2014
  • Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees:  will increase to $2.55 for generic or preferred drug that is a    multi-source drug and $6.35 for all other drugs in 2014

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