H&W: 2013 Medicare Part D Benefit Parameters

2013 Medicare Part D Benefit Parameters2013 Medicare Part D Benefit Parameters: Each year, group health plans that offer prescription drug coverage to Medicare Part D eligible individuals must determine whether this coverage is “creditable.” To be considered creditable, the coverage must be expected to pay out as much as standard Medicare prescription drug coverage pays, on average, for all plan participants.  The plan must disclose to Part D eligible individuals and to The Centers for Medicare and Medicaid Services (CMS) whether the plan coverage is creditable or non-creditable.

CMS recently released the 2013 Medicare standards to be used when determining whether the prescription drug coverage offered by a plan is creditable.

The standards are as follows:

Standard Benefit 2012 2013
Deductible $320 $325
Initial Coverage Limit $2,930 $2,970
Out-of-Pocket Threshold $4,700 $4,750
Total Covered Part D Spending at Out-of-Pocket Threshold for Non-Applicable Beneficiaries $6,657.50 $6,733.75
Estimated Total Covered Part D Spending at Out-of-Pocket Threshold for Applicable Beneficiaries $6,730.39 $6,954.52
Minimum Cost-Sharing in Catastrophic Coverage Portion of the Benefit
Generic/Preferred Multi-Source Drug $2.60 $2.65
Other $6.50 $6.60


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