Medicare Part D Beneficiaries NOT Facing Double-Digit Premium Increases

A September study of government data by Avalere Health originally indicated that Medicare Part D beneficiaries would face double-digit premium increases next year unless they look for less costly plans.

“The Obama Administration has taken steps to close the donut hole by offering $250 rebates to Medicare beneficiaries and requiring all participating Medicare prescription drug providers to offer 50% discounts on brand-name drugs for patients in the doughnut hole in 2011,” reminded Alan Weinstock, insurance broker at “But how far will that take Medicare beneficiaries if the top national plans charge higher premiums?”

In fact, the data from the study showed that seven of the top 10 national plans will increase their premiums by an average of 10% in 2011. Overall they cover approximately 70% of all Medicare beneficiaries.

Avalere Health Changes Original Medicare Part D Increase Prediction

In a reversal of their original prediction, however, Avalere now suggests that premiums for the Medicare Part D prescription drug benefit will only increase by 0.2% in 2011.

Avalere as well as the Kaiser Family Foundation found that Medicare Part D premiums would increase an average of 10% for many beneficiaries. However, new projections from Medicare indicate that one plan — First Health’s Premier Plus — will not be among the top 10 plans, as Avalere originally thought. Instead, Medicare plans to switch beneficiaries enrolled in the Premier Plus plan to First Health’s Premier plan.

The Premier plan likely will increase its monthly premium by about 20% in 2011, compared with the nearly 43% increase in premiums expected in the Premier Plus plan. As a result, the average increase will be lower, according to Avalere’s new estimate.

An additional piece of good news is that Humana Inc. announced a new Medicare Part D prescription drug plan recently. Co-branded with Wal-Mart Stores Inc., the Humana Walmart-Preferred Rx Plan (PDP) offers a single low national monthly premium of only $14.80. This is the lowest national plan premium for standalone Medicare Part D plans.

What Medicare Beneficiaries Can Do to Help Themselves

Medicare beneficiaries who are looking for the right Medicare Part D prescription drug plan for their needs should consider the cost of the premium, amount of any deductibles and whether there a co-payment or co-insurance. It is also important for Medicare beneficiaries to understand the formulary for their chosen plan and whether prior authorization is required.

A formulary is the list of drugs that the Medicare Part D plan covers. They can include generic and brand-name drugs. Formularies must include at least two drugs in the most commonly prescribed drug categories and classes. This insures that Medicare beneficiaries with different medical conditions can get the treatment they need.

In addition, certain drugs may require a prior authorization to obtain. This means before the plan will cover these prescriptions, a doctor must first contact the plan and show there is a medically necessary reason why the beneficiary must use that particular drug for it to be covered.

Whatever Medicare Part D plan beneficiaries choose, it is important to review available plan information carefully in order to make an informed choice.

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