Ohio Prescription Drug Donut Hole 2011

Home / Ohio Tidbits / Ohio Prescription Drug Donut Hole 2011

PART D CHOICES

This is an excerpt taken from the Center for Medicare Advocacy:

…with Medicare Part D – some of us find that our current prescription drug plan isn’t such a good fit these days. That’s because plans change every year. Premiums and deductibles may change, and, worst of all, beneficiaries may find drugs they need taken off their plans’ formularies or made subject to new prior authorization rules and other restrictions. It is a necessity that beneficiaries and their helpers compare different plans before the Part D Annual Election Period from November 15 – December 31.
CMS also projects that for 2011, 1.2 million beneficiaries will have to change plans as a result of plans leaving the market or reducing their service area. The vast majority of people who will need to change, 925,000 of them, are in Private Fee for Service (PFFS) plans that have decided they no longer want to participate in Medicare as a result of additional requirements passed in the 2008 Medicare Improvement for Patients and Providers Act (MIPPA), not the recent health care reform law. The changes from 2008 go into effect for the 2011 plan year.

Beneficiaries whose plans leave Medicare will still have health insurance through the traditional Medicare program. They will have a special enrollment period in which to enroll in a Part D plan or another MA plan, and they will have guaranteed issue rights to certain Medigap policies. Beneficiaries and helpers should pay attention to the plan non-renewal notice if a plan is leaving Medicare, and, if a plan will be available in 2011, they should be sure to read the Annual Notice of Change (ANOC). The ANOC will explain exactly how the plan is changing for next year. If the plan no longer fits a beneficiary’s needs, it’s time to “shop around” for a new plan.

Ohio specific drug Details provided by www.q1medicare.com

Based on the 2011 Medicare Part D plan information released by the Centers for Medicare and Medicaid Services (CMS), Ohio seniors and Medicare beneficiaries will find that 2011 will bring a number of changes to prescription drug coverage and they should be prepared to examine their current 2010 plans closely to see what changes are on the horizon for 2011.

Please note that the information we provide below is based only on stand-alone Medicare Part D prescription drug plans (or PDPs). As many people know, a number of the Medicare Advantage plans also include comprehensive prescription drug coverage, along with Medicare Part A (hospitalization) and Medicare B (physician) benefits (also called MA-PD plans). However, because MA-PDs include many additional features (including Part A & B coverage) as compared to a stand-alone Medicare Part D plan, we do not try to compare the stand-alone drug plans directly with MA-PDs.

What is new for 2011 Medicare Part D Prescription Drug Plans?
First, the number of prescription drug plans available in Ohio has decreased.
Most notably, some carriers have consolidated plans, most notably, the Coventry AdvantraRx Part D plans will be replaced by the Coventry First Health plans and the PrescribaRx plans will be replaced by the CCRx plans (PrescribaRx and CCRx were both provided through Universal American in 2010). The Medicare prescription drug plans from Aetna are not represented in the landscape as Aetna continues to be sanctioned by CMS. However, Fourteen (14) companies will offer 2011 Medicare Part D plans in most states across the country. In addition, a wide assortment of regional and local Medicare Part D plans are offered within each state or CMS region, with the average number of prescription drug plans offered per state decreasing from 46 plans in 2010 to 30 plans in 2011.

Locally, Ohio residents will find that the total number of stand-alone Medicare prescription drug plans has decreased from 46 in 2010 to 31 in 2011.

As a note, if you find that your current 2010 Part D plan is not being offered in 2011, you may wish to review your Part D plan’s Annual Notice of Change (or ANOC) letter to see if you will be automatically moved to another 2011 prescription drug plan or whether you will need to actively choose a new Medicare Part D plan for 2011.

29% of Ohio seniors can expect to see their monthly prescription drug plan premiums increase in 2011.
Across the country, the national average monthly Medicare Part D premium will increase from $46.58 in 2010 to $53.77 in 2011. Based on the 2010 enrollment figures, 64% of Medicare Part D beneficiaries nationwide (over 8 million people) could experience an average increase in premium of $6.74, unless they switch to a lower priced plan. At home, Ohio residents will also notice an increase in their Medicare Part D premiums. 29% of Ohio seniors and other Medicare beneficiaries enrolled in a stand-alone Medicare Part D plan, (or around 111,782 people) will see an average increase in monthly premiums of $9.55 in 2011 — if they do not switch to a lower cost prescription drug plan. Overall, monthly 2011 prescription drug plan premiums in Ohio will increase 6.83% from a 2010 average monthly cost of $45.40 to a 2011 average Part D plan premium of $52.23.

The average monthly premiums discussed above treat all Medicare Part D plans equally. Perhaps a more telling average is the weighted average – that is, looking at each plan’s monthly premium based on number of people enrolled in that plan. Based on the weighted average, Ohio residents can expect to see a 2% increase in their monthly premiums. This means that if everyone stays in their current 2010 prescription drug plan through 2011, then across the state we can expect beneficiaries to pay 2% more for their monthly premium.

The range of monthly drug plan premiums will decrease.
Across the country, 2011 Medicare Part D plan premiums range from a low of $14.80 (Humana Walmart-Preferred Rx Plan (PDP) in WI) to a high of $133.40 (BlueRx Enhanced (PDP) in DC DE MD) . Comparatively, the premiums within Ohio will range from $14.80 (Humana Walmart-Preferred Rx Plan (PDP) in OH) to $111.50 (Humana Complete (PDP) in OH) – as compared to the 2010 Ohio monthly premium range of $22.60 to $102.20. Of those 2011 plans, 1 plans will have a premium under $25 (in 2010, 1 Part D plans were offered in Ohio with a premium under $25).

More Medicare prescription drug plans will offer some level of coverage gap protection.
The selection of prescription drug plan coverage options has also changed with more companies offering 2011 Part D plans with donut hole coverage. In 2010, 9 plans offered plans with some form of donut hole coverage and in 2011 that number will increase to 11. People are reminded to see what drugs are actually covered in the donut hole because some Part D plans only cover a “few” drugs through the coverage gap.

Less Medicare prescription drug plans will offer plans with enhanced options.
Ohio residents will find that less Part D plans will offer enhanced prescription drug coverage options with 14 enhanced Part D plans in 2011 as compared to 23 in 2010. Enhanced Medicare Part D coverage includes prescription drug plans that have a lower or no initial deductible and a variation of cost-sharing (for instance, copayments instead of co-insurance). For example, in 2011, fewer Ohio Part D plans will offer prescription drug coverage with a $0 initial deductible (13 in 2011 as compared to 19 in 2010).

Low-Income Subsidy Recipients in Ohio will have more Part D plans that qualify for the $0 monthly premium.
Ohio Medicare beneficiaries who qualify for full “Extra Help” will find that more Part D plans qualify for the $0 premium Low-Income Subsidy as compared to last year. In 2010, 5 Medicare Part D plans qualified for the $0 premium Low-Income Subsidy as compared to 7 Part D plans in 2011. Please note, if you received “Extra Help” in 2010 and your plan does not qualify for the $0 premium in 2011, you may be automatically moved to a new Part D plan that does qualify for the $0 premium. If this occurs, please check to be sure that your prescriptions are covered on your new plan. If they are not, you can switch to a plan which will cover your medications.

So what is the Bottom Line? Review your 2011 Medicare prescription drug plan options.
Ohio seniors and Medicare beneficiaries will see fewer prescription drug plan choices in 2011 and higher premiums.

In addition, behind the numbers, some of 2010’s more popular Medicare Part D plans will change their 2011 plan structure. Some plans are adding initial deductibles or changing cost-sharing limits (for instance, how much you pay after for a covered drug). Also, some plans actually change the initial coverage limit defining when you enter the coverage gap.

Accordingly, people are reminded to consider their 2011 prescription drug plan options carefully. If you are a Medicare beneficiary and make no decision to change your existing prescription drug coverage, you will be automatically reenrolled in your existing prescription drug plan – along with any changes that have been made in coverage or cost for 2011. If your prescription drug plan is discontinued, and you are not automatically moved into a new plan, then you will need to enroll in another Part D plan or not have prescription drug coverage in 2011.

CMS indicates that the national average monthly premium will increase about $1 (to $30) in 2011, but the overall range of premiums is up among PDPs. In part, this may be because more plans are offering some coverage during the Donut Hole. The most important thing we can say about premiums is: Don’t shop by premium alone! Consumers need to look at total annual costs, including the premium and cost sharing (the deductible, co-pays and co-insurance). Even more importantly, consumers need to compare plan formularies to be sure the drugs they take are offered by the plan with as few restrictions (such as prior authorization) as possible. Beginning October 15, plan premiums, deductibles, co-pay amounts, formularies and formulary drug restrictions can be viewed and compared on-line at www.medicare.gov.

*Total price of the brand name drug counts toward TrOOP, even though member is paying 50%. For generic drugs, only the amount the member pays – 93% – counts toward TrOOP.

Reminders for Selecting a Plan

•First and foremost, compare needed drugs to the drugs on the plan’s formulary. Make sure the needed drugs are on the formulary and have no restrictions (such as prior authorization, quantity limits and step therapy).
•Consider whether or not coverage is needed during the Donut Hole, keeping in mind that this year, most people will get a 50% on brand name drugs purchased while in the Donut Hole.
•If the beneficiary travels, look for a national plan.
•If it is an issue, find out the circumstances when the plan will cover brand name drugs when a generic alternative is available.
•Even after finding a compatible plan, compare annual cost per year, including premium, deductibles and co-pays. Don’t assume that a deductible will make the plan more expensive overall, and don’t assume that mail order is always less expensive.
There are several sources for help in choosing a plan. Compare plans on-line using the Plan Finder tool at www.medicare.gov. Read the “Medicare & You 2011” handbook. Call 1-800-MEDICARE, or contact your local broker.

For a synopsis of 2011 Health and Drug plans in all 50 states go to: http://www.cms.gov/Partnerships/downloads/statefactsheets_all.pdf