CMS released the 2015 changes to Medicare part regulations and policy including the improvement in Medicare Part D donut hole situation in 2015.
The Part D coverage gap, also known as the doughnut hole will continue to close. In 2015, those who reach the coverage gap will receive a 55% discount on brand name drugs—up from 52.5% in 2014—and a 35% discount on generic medications—up from 28% in 2014.
2014 Update-Regarding the gradual closure of the Medicare Part D doughnut hole and the expansion of preventive services at little to no cost for people with Medicare:
If you have a Medicare Part D plan, also known as a Medicare prescription drug plan, the doughnut hole is the period of time during which the amount you pay for your prescription drugs suddenly increases. The doughnut hole is also known as the coverage gap. You enter the doughnut hole in 2014 when your total drug costs (i.e. what you and your plan have paid for your prescription drugs) reaches $2,850. After both you and your plan have paid this amount towards your prescription drugs in 2014, you may fall into doughnut hole and may therefore, have to pay more for your drugs while you are in the doughnut hole.
Just a few years ago, people had to pay the entire cost of their prescription drugs while they were in the doughnut hole. The doughnut hole is being phased out. In 2014, you will still be responsible for paying 47.5% of the cost of brand-name drugs and 72% of the cost of generics drugs if you are in the doughnut hole. By 2020, the doughnut hole will be completely closed, meaning that people in the doughnut hole will not have to pay more than 25% of the cost of their covered brand-name and generic prescription drugs at any point during the year.
Also New for 2014- Medicare covers many preventive services at little to no cost to you. As long as you meet basic eligibility standards, you have the right to receive these services even if you have Original Medicare or a Medicare Advantage plan (Medicare private health plan). More info:
If you have Original Medicare you will have no coinsurance or deductible for certain preventive care services if you see a doctor or other health care provider who accepts assignment. Doctors who accept assignment cannot charge you more than the Medicare approved amount.
Medicare Premiums and Deductibles Held Steady for 2014
The Centers for Medicare & Medicaid Services (CMS) announced that the 2014 Medicare Part B premium remained $104.90 per month which is the same as in 2013. The Part B deductible (if one’s supplement does not cover this) will also remain $147.00; the same as in 2013.
Reminder: Fall Open Enrollment occurs from October 15 to December 7 of every year.
If you enroll in a plan during Fall Open Enrollment, your coverage starts January 1.
In most cases, Fall Open Enrollment is the only time you can pick a new Medicare Advantage or Medicare Part D plan.
If you have Medicare Advantage, you can also switch to Original Medicare. To get Medicare drug coverage, you can must join a stand-alone Part D plan at this time.
If you are unsatisfied with your Original Medicare coverage, you can make changes to your coverage during Fall Open Enrollment. Changes made to your coverage will take effect January 1 of the next year.
If you want to join a stand-alone prescription drug plan (PDP) , use the Plan Finder tool on Medicare.gov. ThePlan Finder tool compares plans based on the drugs you need, the pharmacy you go to and your drug costs.
If you want to join a Medicare Advantage plan, call 800-Medicare to find out what plans are in your area. When you receive the list of plans, check the plan websites to see which best fits your needs.
After you have researched a plan online, call the plan itself to confirm what you learned. Make sure the plan includes your doctors and hospitals in its network. Confirm that the plan covers all your drugs, and that your pharmacies are in the preferred network. Write down everything about that conversation. In your notes, record the date of the conversation, whom you spoke with, and the outcome of the call. This information may help protect you in case a plan representative gives you misinformation.
Optional service available to everyone: Call or visit the website of your State Health Insurance Assistance Program or SHIP. Your state SHIP can help you to understand all of your Medicare coverage options.
Enrolling in a new plan by calling Medicare is the best way to help protect you if there are problems with enrollment. Write down everything about the conversation when you enroll through Medicare. In your notes, record the date of the conversation, whom you spoke with, and any information you were given during the call.
Before you enroll with Medicare, confirm all of the details about your new plan with the plan itself.
If you are dissatisfied with your Medicare Advantage plan, you can disenroll from that plan and join Original Medicare during the Medicare Advantage Disenrollment Period (MADP).
The MADP is every year from January 1 to February 14.
Understand the difference between the Fall Open Enrollment Period and Open Enrollment for the Health Insurance Marketplaces.
Since October 1, 2013, the Health Insurance Marketplaces (also known as Exchanges) held and are holding open enrollment for uninsured or underinsured Americans. The Marketplaces are not meant for people with Medicare. People with Medicare should not use this open enrollment period to purchase or change their health care.
People with Medicare should continue to use the Fall Open Enrollment Period to review and make changes to their health coverage.