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2013 Part D Changes

Do you have questions about changes to 2013 Part D plans?Word - Question Surrounded by Question Marks

Just as sure as politicians blame each other for the County’s problems you know that each year there will be changes to Medicare Part D plans.

2013 Part D plans will be no different. Some changes are quite clear to see because the Medicare prescription drug program is regulated by the federal government. The Standard Benefit Model for the Part D program dictates that certain features of Part D plans adhere to set guidelines.

But some of the changes to 2013 Part D plans will require a little digging to get to the facts. This article will summarize changes to the Part D Standard Benefit Model as well as point  you in the right direction to learn more about changes to individual plans.

What Does Medicare Part D Cost?

2013 Part D Standard Benefit Model Changes

The Standard Benefit Model refers to the parameters that are common to each plan. It doesn’t matter whether you are considering a 2013 AARP Medicare Rx plan or the Humana Walmart-Preferred Rx PDP the following features and limits will be the same.

  • The Part D deductible can be as low as $0 or as high as $325.
  • The initial coverage limit has been increased to $2970 for .
  • The out-of-pocket threshold amount has been increased to $4750.
  • The 2013 Part D donut hole You will be responsible for $4750 in true out-of-pocket costs.
  • Catastrophic coverage portion after you have met 100% of donut hole expenses will require you to pay the greater of 5% or $2.65 for generic or preferred drugs and the greater of 5% or $6.60 for all others.

Uncovering changes to specific 2013 Part D plans

Changes to a Part D plan may include:

  • Change in monthly premium
  • Change in the plan’s deductible
  • Changes to copay or coinsurance amounts
  • The plans formulary can change by adding or omitting drugs or changing the tier in which  a drug is placed
  • Changes to the  pharmacy network or mail order benefit

If you are interested in learning if your current plan will include changes you should review your Annual Notice of Change. This notice will detail all changes to become effective for the 2013 Part D calender year.

If you are interested in learning about the details of another Part D plan you can visit the Medicare website to locate all available Part D plans for your State. To determine if the plan will meet your needs you should review the plan’s costs and benefits and specifically review the plan’s formulary.

The Part D formulary will provide all the information required to choose the right Part D plan.



  1. Matt, Good point. You should also check for any changes to tier placement within the same plan from 2011 to 2012.

  2. My elderly parents have a Blue Cross Advantage Plan. Can they keep the same plan and just add dental?

    They are in great need of dental coverage.

  3. Martha, You could check to see if the Blue Cross Medicare advantage plan has an optional dental rider and if so you should be able to add it. If not they could shop for a stand-alone dental plan. Keep in mind that most plans will have a hefty premium, have a waiting period for many procedures and have a cap on annual maximum coverage. After doing the math many people recognize that it’s often better to pay for required dental care and avoid the waiting period which can often last for a year or more.

  4. For 2012 am I required to have drug coverage even though I am not on any drugs? Where do I find this info in black and white?

  5. Paul, Nothing in this article indicated that you are required to have Part D coverage. If you are eligible for Medicare and do not have credible coverage from another source, such as an employer group plan, and do not enroll in a plan you will be subject to a late enrollment penalty when and if you do enroll.

  6. Dose any one know where I can find the Humana 2012 drug formulary for Illionis?

  7. Jim, Here’s a link to Humana’s PDP formularies. Be sure to choose the Humana Part D plan in Illinois that you are considering. Humana offers 3 Part D plans and each will have a different formulary.

  8. How long must you pay this penalty if you did not register at the start of this program?

  9. John, If you are subject to the Part D late enrollment penalty you will pay it for as long as you have Part D.

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