Content below updated July 19, 2014

2015 Part D (Medicare Prescription Drug Plan) Standard Benefit Beneficiary costs

The 2015 Medicare prescription drug plan deductibles and other limits are now out.   How these changes will be implemented in your existing plan will be known in October of 2014.  At that time, we encourage you to evaluate your 2015 out of pocket costs for prescription medications and compare it to your 2014 out of pocket costs.  We encourage you to consider changing plans if your 2015 out of pocket costs will cause you financial discomfort.  If you are a resident of Idaho and want help understanding your 2014 out of pocket costs, projected out of pocket costs for 2015, and thinking through if changing plans makes sense, contact us on 208-867-0296.  You can change plans between October 15th and December 7th.  If you do not change plans, the plan in which you are presently enrolled will remain your plan for 2015.  We are here to help.

The 2015 changes are:

The annual deductible will be $320

Coverage gap:  when the insurance company’s cost of your medications exceeds $2,960, you will enter the coverage gap.  When this happens, your share of the cost of your medications changes.  You will pay 65% of your plans cost for generic medications and 47.5% of the cost of your brand named medications.  Once your out of pocket cost for your medications (and the 50% contribution the drug manufacturer makes towards the cost of your brand named medications while in the coverage gap) reaches $4,700 you enter the ‘catastrophic coverage’ phase.

Catastrophic coverage:  when you enter this phase, your co-pay for your generic medications will be $2.65 per refill; your brand named medications changes to the larger of 5% of the cost of the medication or $6.60.

Content below updated June 16, 2014

More New Medications (brand and generic) are available now

Several new medications (brand name and generic) have been approved by both the FDA and some have been included in the Medicare formulary in 2014.  This occurs throughout the year.

What this means to you:  brand named medications you take may have gone ‘generic’ and have been approved for inclusion in the Medicare formulary (list of medications they subsidize).  This may mean you:

can save money on your medication cost if you switch to the generic version of the brand named medication you take; and

if you are taking a brand named medication (and a generic is not available) a lower cost brand named medication may now be available.

What we recommend:  you take the time to check if a lower cost medication is available for the prescription drugs you presently take.  If there is, contact your doctor and talk it over with them so see they recommend you trying the lower cost medication.  Then check to see if the insurance carrier that covers your prescription medication includes that medication in their formulary. Insurance companies update their list of covered medications throughout the year and you have to check with them (call or check their web site) to see if they currently or plan to cover this medication.

How you can check for the availability of new medications

The FDA posts updates on this subject here

Find out when other popular medications are going generic by checking the list found here.


What else do I need to be aware of:

Not all Medicare prescription drug plans include new medications in their plan’s formulary.  Just because the medication is listed in Medicare’s formulary, does not mean your plan has done the same.  This means generic or brand named medications available to you may not be included in your plan’s formulary unless you go through your plan’s ‘appeal processes’.  How you do this is documented in the  plan’s documentation you received when you enrolled in your plan.   Be sure and check your plan’s documentation to see how much you will pay for medications that are approved from the appeal process.

If you are interested in lowering your annual cost for prescription medications, follow the above process. If you are a resident of Idaho and would like help, call us.  This is part of a normal service we provide to all of our customers (people that enroll in a Medicare plan through our agency).  There is no cost for this service.


Content below updated October 29, 2013

Money saving improvements noticed in 2014 choices

While working with people interested in saving money on their 2014 prescription drug plans, we have noticed innovative changes introduced in our choices.  We are seeing plans where tier 1 (generic) and tier 2 (non-preferred generic) medications are exempt from the 2014 $310 deductible.  This can mean attractive savings for beneficiaries that take mostly generic medications.  Some mail order plans have zero dollar cost for tier 1 and 2 generic med’s at the 90-day order level.

We have noticed generic med’s being placed in all five tiers too.   The message here is do not assume that the generic med’s you take will always be in your plan’s tier 1 or 2 formulary.

Beneficiaries using Spiriva, a medication frequently used to treat COPD, may have noticed a lower cost alternative that was FDA approved in 2012.  You can learn more about Tudorza Pressair here.   Other popular brand named medications that will have newly available generics are noted below.  If you know people that take any of these medications, you might bring this to their attention; they should check with their doctor and see if these lower cost alternatives will work for them.     These are:

        Aciphex                Comtan              Exforge          Niaspan              Zomig

        Actonel                 Cymbalta          Lidoderm       Opana                 

        Advicor                Detrol La           Lovaza           Rapamune  

        Antara                  Evista                 Lumigan        Renvela

        Atacand               Exalgo                Micardis        Viracept

        Celebrex               Exelon                Nexium         Vivelle Dot


If you are an Idaho resident and have not had your prescription drug plan compared to the alternatives in a while (this includes people with MAPD plans too), you may be leaving money on the table.  Contact us if you would like help reviewing your alternatives.


Content below updated October 11, 2013

Idaho Prescription Drug Plan Changes for 2014

Mining the CMS data about 2014 Prescription drug plans available to Idaho residents produced the information below.

Number of plans available to Idaho Residents:   32

Number of plans with a zero dollar deductible: 14

Lowest cost plan available:  $12.60

Highest cost plan available: $138.80

Number of plans with Gap coverage: 6

Number of plans with a premium decrease:  9

Number of plans with a premium increase: 16

If you have experienced an uncomfortable increase in your monthly premium for your 2014 prescription drug plan and would like help analyzing your alternatives, contact us. We will help you explore your options and if a more cost effective plan is available, help you enroll in that plan.

Content below updated September 26, 2013


It’s official; the July 30, 2013 press release from HHS regarding Prescription Drug Plan changes for 2014 is below.  The original is available here.  Note that “the average premium for a basic prescription drug plan in 2014 is projected to remain stable, at an estimated $31 per month”.  If your PDP plan’s monthly premium increased by an uncomfortable amount without corresponding savings in copays, deductibles, help in the coverage gap or formulary updates,  contact us; we will compare your current plan with others available for 2014.  Remember, if you want to make a plan change, you have to do it between October 15th and December 7th of 2013.




July 30, 2013
Contact: HHS Press Office
(202) 690-6343

Medicare drug premiums remain stable four years in a row

On the 48th anniversary of the signing of Medicare and Medicaid into law, the Department of Health and Human Services (HHS) released data showing that the average premium for a basic prescription drug plan in 2014 is projected to remain stable, at an estimated $31 per month.

This news comes as seniors and people with disabilities continue to save money on out of pocket drug costs. Yesterday, HHS announced that more than 6.6 million people with Medicare have saved over $7 billion on prescription drugs as a result of the Affordable Care Act, an average of $1,061 per beneficiary. The Affordable Care Act closes the donut hole over time.

“Seniors are benefiting from improved benefits and low premiums, thanks to a competitive and transparent marketplace for Medicare drug plans,” said HHS Secretary Kathleen Sebelius.

For the fourth straight year, the average Medicare Part D monthly premium will remain steady, and is projected to be $31. For the last three years – for plan years 2011, 2012, and 2013 – the average premium was projected to be $30. Today’s projection for the average premium for 2014 is based on bids submitted by drug and health plans for basic drug coverage during the 2014 benefit year, and calculated by the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary.

CMS has already announced that key parameters for Part D will actually be lower in 2014 than in 2013.  For example, the Part D deductible will fall from $325 to $310, producing additional savings for enrollees.

The upcoming annual open enrollment period – which begins October 15 and ends December 7 – allows people with Medicare, working with their families and their caregivers, to choose their plans for next year by comparing their current coverage and quality ratings to other plan offerings. New benefit choices are effective Jan. 1, 2014.

To learn more about the Affordable Care Act, go to


Content below updated 8/30/2013

The prescription drug plan changes for 2014 are noted below.  They will become effective January 1, 2014 and will be implemented in all prescription drug plans available to you.  This means if you currently have a standalone prescription drug plan or have prescription drugs covered in your Medicare Advantage plan, you will see these changes.   If you want help understanding how your out of pocket costs will change next year based on these (or the changes your insurance company may make to your current plan), feel free to contact us.   We will review your current drug plan, out of pocket costs, and your options for next year (changing plans).  If any of these changes will save you money and you want to change plans, we will help you do so.  Changing plans takes 30 – 60 minutes.  Your new plan will be effective January 1, of next year.   Here are the highlights for the CMS defined Standard Benefit Plan changes from this year to next. This “Standard Benefit Plan” is the minimum allowable plan to be offered.

  • Initial Deductible: will be decreased by $15 to $310 in 2014
  • Initial Coverage Limit: will decrease from $2,970 in 2013 to $2,850 in 2014
  • Out-of-Pocket Threshold: will decrease from $4,750 to $4,550 in 2014
  • Coverage Gap: begins once you reach your Medicare Part D plan’s initial coverage limit ($2,850 in 2014) and ends when you spend a total of $4,550 in 2014. In 2014, Part D enrollees will continue to receive a 52.5% discount on the total cost of their brand-name drugs while in the coverage gap.  The 50% discount paid by the brand-name drug manufacturer will still apply to getting out of the donut hole; however the additional 2.5% paid by your Medicare Part D plan will not count toward your TrOOP. Enrollees will pay a maximum of 72% co-pay on generic drugs while in the coverage gap.
  • Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit**: will increase to greater of 5% or $2.55 for generic or preferred drug that is a multi-source drug and the greater of 5% or $6.35 for all other drugs in 2014
  • Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees:  will increase to $2.55 for generic or preferred drug that is a    multi-source drug and $6.35 for all other drugs in 2014


Content below updated July 25, 2013

Will Your Out of Pocket Costs for Medications Change Next Year?

Probably.  Remember, insurance companies can change their plans annually; these changes can easily be reflected in both your out of pocket cost and convenience in having your prescriptions filled.  Not all plans have the same copays, deductibles, formulary, drug tiers, pharmacy networks, and have the same medications under ‘plan management’.

If your medication costs for this year went up, it makes sense for you to shop for a new plan between October 15th and December 7th (your Annual Election Period for Medicare Advantage and Prescription Drug Plans).   Doing so could save you both money and convenience in having your prescriptions filled.  If you have an MAPD plan and are concerned about seeing the same doctor or having access to the same hospitals, etc. we suggest you work with an independent insurance agent that specializes in Medicare AND one that carries all of the MAPD plans available in your area.

If you are an Idaho resident and would like help,  contact us. 


This page was last modified on Dec 27, 2014 @ 6:18 AM