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2013 Part D and Medicare Advantage plan landscape information

Views: 4800
Posted: 21 Sep, 2012
by Cathy Roberts (Empire Justice Center)
Updated: 29 Apr, 2013
by Cathy Roberts (Empire Justice Center)

The Part D and Medicare Advantage annual coordinated election period for 2013 ran from October 15 through December 7th, 2012.  But see information about extension because of Hurricane Sandy!!   And note that there are two Part D sponsors who are not allowed to enroll new members due to sanctions issued by CMS - Silverscript (sanction effective January 15, 2013) and SmartD Rx (sanction effective April 23, 2013).

Check out the lists of 2013 Plans for New York State:

... And remember that the benchmark amount for 2013 is $43.22 ... de minimis is $2. "Benchmark" plans are free to people with full Extra Help.

The attached chart shows the 12 “benchmark” plans that have a FREE PREMIUM for people on SSI, Medicaid, an MSP or Extra Help thru SSA. It also shows whether the same plans were also free in 2012, and what 2012 plans will be discontinued in 2013.

NINE of the twelve 2012 benchmark plans will continue to be benchmark plans offered in 2013. Clients who were in the 2012 version of the plan will automatically be assigned to the 2013 version. These are:

1. Aetna CVS/pharmacy Prescription Drug Plan,

2. Cigna Medicare Rx Plan One,

3. First United American Select

4. SilverScript Basic (formerly known as CVS Caremark Value) - suspended from enrolling new members as of January 15, 2013

5. Wellcare Classic,

6. Envision Rx Plus Silver,

7. Express Scripts Medicare Value (formerly known as Medco Value),

8. Humana Walmart-Preferred Rx Plan, and

9. HealthSpring Prescription Drug Plan -Reg 3 (PDP)

NEW PLANSThere will be three NEW additional benchmark plans in 2013:

10. First Health Part D Essentials

11. SmartSaver Rx PDP, and

12. SmartD Rx Saver PDP - suspended from enrolling new members as of April 23, 2013.

TWO 2012 Benchmark Plans have been discontinued:

  • Bravo Rx by Bravo Health (will be reassigned to HealthSpring Prescription Drug Plan -Reg 3) and
  • Community CCRx Basic by Community CCRx PDP (will be reassigned to SilverScript Basic).

ONE Plan that will LOSE benchmark status in 2013 – AARP MedicareRx Preferred (United Health) – We previously reported that, because this plan's 2013 premium will be less than $2.00 over the benchmark amount, it would be free for members with Full Extra Help.  We recently found out that this is NOT TRUE.  UnitedHealthcare has chosen to bill its members with Extra Help for the $0.50/mo. premium (yes, that's fifty cents), rather than waive it under the de minimis policy, as CMS permits them to do.  People with Full Extra Help who were auto-assigned to this plan by CMS will be reassigned to a different plan that is below benchmark for 2013.  Those with Full Extra Help who chose this plan will NOT be reassigned, and thus will be vulnerable to increased costs in 2013.  They can switch to a different plan anytime in December for an effective date of January 1.  Those with EPIC will not have to pay the extra $0.50/mo. because EPIC's premium subsidy will cover it.


HURRICANE SANDY UPDATE -- EXTENSION PAST DEC. 7, 2012 for 2013 enrollment

Nov. 7, 2012 - CMS  granted the Medicare Rights Center's request to allow persons affected by Sandy to enroll in Part D or C (Medicare Advantage) outside of the Annual Enrollment Period, which would otherwise end Dec. 7, 2012. (MRC is  following up separately with the Social Security Administration regarding Part A and B enrollments.) There's no time limit for people to enroll.  They just need to call 1-800 Medicare, and explain that they were adversely affected by the hurricane. Individuals don't need to prove that they live in an area affected by Sandy.  The extension also applies to individuals who don’t live in the affected area but rely on help making healthcare decisions from friends or family members who live in the affected areas. Here is a link to the Medicare Rights Center’s press release about the extended enrollment period for those affected by the hurricane.  Link to CMS Memorandum.

We strongly recommend that people review their plan choices for 2013 to make sure that they are enrolled in the plan that is best for them.

Click here for the Medicare Rights Center's excellent Fall Open Enrollment Tools that can help you select the best plan. 

Attached files
file SNP Landscape 2013.pdf (110 kb)
file MA Landscape 2013.pdf (108 kb)
file Benchmark Plans 2013-2014 Comparison.pdf (28 kb)
file PDP Landscape 2013.pdf (88 kb)
file 2013landscapesource file medicare advantage in nys.xls (460 kb)
file 2013LandscapeSource file SNP nys.xlsx (66 kb)

Also listed in
folder Medicare Part D -> What drugs are covered?
folder Medicare Part D -> Extra Help
folder Medicare Part D -> Selecting a drug plan
folder Medicare Part D -> Getting Started
folder Medicare Part D -> Overview

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