2012 Medicare Part D Plans in NYS

Medicare's Annual Open Enrollment for 2012 is from Oct. 15 - Dec. 7, 2011

On September 15, 2011, CMS announced the Part D and Medicare Advantage plans for 2012.  CMS announced them earlier than usual because the ANNUAL OPEN ENROLLMENT PERIOD for 2012 is earlier this year -- it will start October 15, 2011 and continue through December 7, 2011.  In the past, the enrollment period was from Nov. 15 - Dec. 31st for the following year.   If you don't enroll in or change Part D plans by December 7th,  you may not be able to change plans or enroll in Part D for the first time until 2013 -- unless you are eligible for a "Special Enrollment Period" (SEP).   SEE below about special EPIC SEP.  During this time you can also enroll in a Medicare Advantage (MA) plan, which is a managed care plan that manages and controls access to all Medicare services -- some include Part D (MA-PD) and some don't.

from http://www.cms.gov/center/openenrollment.asp

• Open Enrollment Information on Medicare.gov

• List of NYS standalone PDPs for 2012

• List of NYS Medicare Advantage plans for 2012

  • List of NYS Medicare Advantage plans by County with enrollment figures for Jan. 2012 and Capitation Rates

• List of NYS Special Needs Plans for 2012

• Comparison of NYS Benchmark Plans 2011-2012

In New York in 2012, according to the 2012 CMS State Fact Sheet   there are

29 Medicare Prescription Drug Plans (PDPs) available - (down from 33 in 2011)

Download list here.  These are stand-alone plans for people with "Original Medicare" who are not in "Medicare Advantage" plans that have Prescription Drug coverage.  Of these --

• 13 PDPs have $-0- annual deductibles.  16 PDPs have the maximum deductible allowed which is  $320/year.  The other 3 plans have deductibles of $140, and $250, $300. 

NOTE:  EPIC members should look for plans with no deductible, since EPIC will no longer help with drug costs during the deductible period

•  MONTHLY PREMIUMS

  • $15.10 is the lowest monthly premium for a prescription drug plan (Humana Walmart-Preferred Rx Plan)

  • $109.70 is the highest premium (Simply Prescriptions Rx3)

  • $65.50 is the lowest monthly premium for a prescription drug plan with SOME coverage for generic drugs in the coverage gap (Rite Aid EnvisionRxPlus (PDP) 

  • People with EXTRA HELP pay NO premium if they are in one of 12 "Benchmark Plans" - see below.  

12 of the 29 PDPs are "Basic" or "Benchmark" plans - Free for "Extra Help".  

This means that for 45% of all Medicare beneficiaries in NYS -- those who qualify for "Extra Help"  -- also called the Low Income Subsidy (LIS) meaning they have Medicaid, are in a Medicare Savings Program, or otherwise qualify:

• The monthly premium is free, even if the chart shows there is generally a premium.  It is fully subsidized.  (If they want to join a different plan than one of these 12 plans they may, but they would have to pay part of the premium - roughly the amount over $39.79).

• There is no annual deductible, even though the chart shows all but 2 of these plans charges a $320 deductible

• The copayments are only $2.50 for generic drugs and $6.50 for brand name drugs.

• Drugs are fully covered in the doughnut hole/coverage gap, with copayments the same as in the bullet point above, even though none of these plans otherwise cover ANY drugs during the doughnut hole.   

• List of Benchmark Plans in NYS - 2012: (note 2 new ones from 2011)

  1)    AARP MedicareRx Preferred (PDP)
  2)    Aetna CVS/pharmacy Prescription Drug Plan (PDP) (NEW in 2012)
  3)    BravoRx (PDP)
  4)    CIGNA Medicare Rx Plan One (PDP)
  5)    Community CCRx Basic (PDP)
  6)    CVS Caremark Value (PDP)
  7)    EnvisionRxPlus Silver (PDP)
  8)    HealthSpring Prescription Drug Plan -Reg 3 (PDP)
  9)    Humana Walmart-Preferred Rx Plan (PDP)
  10)  Medco Medicare Prescription Plan - Value (PDP)
  11)  WellCare Classic (PDP)
  12)  First United American - Select (PDP)   (NEW in 2012)

1 plan that was benchmark in 2011 is no longer a Part D plan at all -- Advantage Star Plan by RX America.  Members of this plan who have Extra Help will be randomly assigned to one of the 12 benchmark plans unless they select their own plan.

Note:  you can get the PDPs for all 50 states at 2012 PDP Landscape Source Files (v.09.15.11) [ZIP, 95KB] 

Selecting the best drug plan for 2012 is especially important for EPIC members who do NOT HAVE "EXTRA HELP"--

• EPIC coverage is being cut back significantly in 2012.   In addition to the usual factors -- finding the plan that covers as many of your prescriptions as possible without "utilization controls" such as quantity limits, EPIC members may:  

  • want to find a plan with no annual deductible

  • not need to be concerned with finding a plan with coverage during the doughnut hole/coverage gap -- since EPIC will cover drugs during this period.  In fact that is ALL EPIC will cover, aside from paying the premium for the lower income EPIC members.Read more about the EPIC changes here and here.  And learn strategies to help clients cope with these changes here.  

The Medicare Advantage and Special Needs Plans are private managed are plans that provide not only Part D drug coverage, but also all other Medicare-covered services.  If you have one of these plans, you can no longer use your Original Medicare card, but instead must receive all services through the Medicare Advantage plan.  Make sure that your doctors, hospitals, and other providers are in the plan's network before enrolling.  The Medicare Advantage plans offered vary from county to county.  Visit the CMS website or use the Medicare Options Compare website to see other counties, and to compare and learn more about specific Medicare Advantage plans.

SPECIAL ENROLLMENT PERIOD (SEP) FOR EPIC MEMBERS -- One perk of being in EPIC is that members may change Part D plans once during a calendar year just because they are in EPIC... without qualifying for another SEP - See more about other SEPs here.  We just learned that EPIC members who have not used their EPIC SEP in 2011 will be able to change plans between December 7 - December 31, 2011 (if they missed the enrollment period that ended Dec. 7th).  AND they can use their 2012 EPIC SEP to change plans in 2012. 

This article written by Selfhelp Community Services and Empire Justice Center.