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