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CMS Allows 3 Percent Growth Rate for Medicare Advantage, Part D

By Jane Norman, CQ HealthBeat Associate Editor

April 2, 2012 -- Officials at the Centers for Medicare and Medicaid Services recently announced that the estimated annual average reimbursement growth rate for Medicare Advantage and Part D prescription drug plans in 2013 will be 3.07 percent.

The average plan increase is likely better news than last year's increase for the private health plans that serve Medicare patients; the reimbursement increase then was 0.4 percent on average. This year's uptick, beginning Jan. 1, will promote a "stable" landscape for the plans' insurers, officials said.

Specific increases will vary by plan and geographic area.

In addition, Medicare officials said that there will also be improved "doughnut hole" coverage for seniors as authorized under the health care law (PL 111-148, PL 111-152). In 2013, seniors who spend so much that they reach the coverage gap will pay 47.5 percent of the costs of covered brand-name drugs. This year they paid 50 percent.

In Part D, the deductible will be $325 in 2013 compared to $320 in 2012. Total drug costs after the deductible, but before the doughnut hole, will be $2,970 in 2013 compared to $2,930 in 2012.

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