*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***

Chapter 22 - Standards and Guidelines	Effective: December 1, 2014
22.55 - Medicare Cost Sharing Amounts	Archived: June 1, 2016 (Previous Versions)

Medicare Cost Sharing Amounts

This section lists Medicare cost sharing amounts.

Medicare Part A.

Medicare Part B.

Medicare Part D.

2015 Cost Sharing Amounts

2014 Cost Sharing Amounts

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Medicare Part A

The following charts provide the Medicare Part A cost sharing amounts.

Premium - Medicare Part A (paid monthly)
Year	People with 30-39 quarters of Medicare-covered employment	People with less than 30 quarters of Medicare-covered employment
2015	$224	$407
2014	$234	$426
2013	$243	$441
2012	$248	$451
Note: Not all Medicare recipients have to pay a premium for Part A coverage.

Deductible - Medicare Part A (per benefit period for hospital stays that are 60 days or less)
Year	Deductible Amount
2015	$1,260
2014	$1,216
2013	$1,184
2012	$1,156

Skilled Nursing Facility Coinsurance - Medicare Part A (per benefit period)
Year	Days 1 - 20 (per day)	Days 21 - 100 (per day)
2015	$0	$157.50
2014	$0	$152.00
2013	$0	$148.00
2012	$0	$144.50
2011	$0	$141.50

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Medicare Part B

Medicare Part B amounts vary by enrollee. The amount of the Part B premium depends upon when the enrollee first became eligible for Medicare Part B, the enrollee’s income and tax filing status. Send a SVES query to determine the amount of the Part B premium for which an enrollee is responsible.

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Medicare Part B - Other Cost Sharing Amounts

The following chart provides the Medicare Part B deductible amounts for each year.

Deductible - Medicare Part B
Year	Annual Deductible
2015	$147
2014	$147
2013	$147
2012	$140

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Medicare Part D

2015 Premium Amounts

The following chart provides the Medicare Part D cost sharing amounts for enrollees for 2015 based on whether or not a client is receiving Extra Help.

2015
	Premium Cost*	Annual Deductible	Co-Insurance Cost	Coverage Gap Costs	Copayments
Standard Benefit	Varies by plan	$320	25% of drug costs between $320.01 and $2,960 Cap of $6,680	55% discount on Brand name drugs; 35% discount on generic drugs between $2,850.01 and $6,455.00	$2.65 generic drugs; $6.60 brand name drugs
Extra Help - Full Subsidy	$0**	$0	None	None	$1.20 generic drugs; $3.60 brand name drugs***
Extra Help - Partial Subsidy	Sliding scale premiums	$63	15%	None	$2.65 generic drugs; $6.60 brand name drugs
Note: To find a Part D premium amount for a specific plan, see the Medicare web site. To find the amount of a Part D premium for which a client may be responsible, see 2015 Amounts in Excess of Medicare Part D Benchmark to Apply as Medical Expense. Note: If enrolled in benchmark plan. If not, Extra Help pays the standard premium amount and the Medicare recipient pays premium costs in excess of the standard. **Note: MA enrollees who reside in a medical institution, nursing facility or ICF/DD whose costs are paid by MA, or who receive Home and Community Based Services are exempt from copayments.

Note: Beneficiaries who have higher incomes and exceed the same thresholds that apply to the Part B premium will pay a monthly Part D income-related adjustment amount. The beneficiary will pay the monthly premium to the Plan and then pay the income-related adjustment to Medicare.

Minnesota 2015 Benchmark Amount: $30.

2014 Premium Amounts

The following chart provides the Medicare Part D cost sharing amounts for enrollees for 2014 based on whether or not a client is receiving Extra Help.

2014
	Premium Cost*	Annual Deductible	Co-Insurance Cost	Coverage Gap Costs	Copayments
Standard Benefit	Varies by plan	$310	25% of drug costs between $310.01 and $2,850 Cap of $6,455.00	52.5% discount on Brand name drugs; 28% discount on generic drugs between $2,850.01 and $6,455.00	$2.55 generic drugs; $6.35 brand name drugs
Extra Help - Full Subsidy	$0**	$0	None	None	$1.20 generic drugs; $3.60 brand name drugs***
Extra Help - Partial Subsidy	Sliding scale premiums	$63	15%	None	$2.55 generic drugs; $6.35 brand name drugs
Note: To find a Part D premium amount for a specific plan, see the Medicare web site. To find the amount of a Part D premium for which a client may be responsible, see 2014 Amounts in Excess of Medicare Part D Benchmark to Apply as Medical Expense. Note: If enrolled in benchmark plan. If not, Extra Help pays the standard premium amount and the Medicare recipient pays premium costs in excess of the standard. **Note: MA enrollees who reside in a medical institution, nursing facility or ICF/DD whose costs are paid by MA, or who receive Home and Community Based Services are exempt from copayments.

Minnesota 2014 Benchmark Amount: $32.23.

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