56 Prescription Drug Plans (PDPs) Statewide
- 9 benchmark plans ($0 monthly premium for people with extra help – low-income subsidy (LIS))
- No national or CA statewide plan provides brand-name drug coverage during donut hole gap; some CA plans provide all generics, or preferred generics in donut hole gap
- Average premium for all PDPs nationwide is rising 8.7% to $40 a month (Avalere Health LLC)
- Up from 2007 average of $36.81
- CMS says average basic premium will be $25 – discrepancy because Avalere Health’s average includes enhanced plans, into which most people enroll, and CMS’ figure includes Medicare Advantage plan premiums (such plans often charge $0 premium for Part D drug benefits)
- Most of the plans with the largest enrollment will increase their monthly premiums $5 to $10 a month (Avalere Health LLC)
- E.g. UnitedHealth – plan with largest market-share (currently approx 6 million enrollees) – raised its prices about $5 a month to average $32, which put it over benchmark for duals in 18 out of 34 regions nationally, resulting in 650,000 duals who will need to be switched to other carriers (Avalere)
- CA PDP premiums range from $14.30 (First Health Part D) to $102.70 (Humana PDP Complete)
Medicare Advantage Plans (58 counties in CA)
Monthly premiums range from: $0 (multiple plans) to $126 (Health Net, Santa Barbara);
- Regional PPO offered in every county (just like 2007) – BC Freedom Blue 1 and 2
- MSA - offered in every county (just like 2007) BC SmartSaver Plan I, II, III
- Demo plans – Fresenius (ESRD) – Alameda, Contra Costa, Imperial, Sacramento, San Diego, San Joaquin, San Mateo, Santa Clara, Solano
- Local PPO – San Diego
- Local HMOs – Alameda, Amador, Contra Costa, El Dorado, Fresno, Kern, Kings, Los Angeles, Madera, Marin, Mariposa, Napa, Nevada, Orange, Placer, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Solano, Sonoma, Stanislaus, Sutter, Tulare, Ventura, Yolo, Yuba
- PFFS plans – multiple plans offered in every county
