Medicare Cost-Sharing Amounts (Archive)

This section lists Medicare cost-sharing amounts.

Medicare Part A.

Medicare Part B.

Medicare Part D.

2010 Cost-Sharing Amounts.

2009 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

2010

$254

$461

2009

$244

$443

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

2010

$1,100

2009

$1,068

 

Skilled Nursing Facility Coinsurance - Medicare Part A

(per benefit period)

Year

Days 1 - 20
(per day)

Days 21 - 100
(per day)

2010

$0

$137.50

2009

$0

$133.50

 

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Medicare Part B

Medicare Part B Beneficiaries Who File an Individual Tax Return (Not Married)

Income Ranges

2010

$85,000 or less    

$85,001 - $107,000

$107,001 - $160,000

$160,001 - $214,000

$214,001 or more

$110.50*

$154.70

$221.00

$287.30

$353.60

*Clients who received Medicare Part B in 2009, had income at or below $85,000, and had their premiums withheld from their Social Security or Railroad Retirement may pay a lower amount.

2009

$85,000 or less  

$85,001 - $107,000

$107,001 - $160,000

$160,001 - $213,000

$213,001 or more

$96.40    

$134.90

$192.70

$250.50

$308.30

 

Medicare Part B Beneficiaries Who File an Individual Tax Return (Married)

(use these figures if person is filing separately from spouse and lived with the spouse at any time during the year)

Income Ranges

2010

$85,000 or less    

$85,001 - $129,000

$129,001 or more

$110.50*

$287.30

$353.60

*Clients who received Medicare Part B in 2009, had income at or below $85,000, and had their premiums withheld from their Social Security or Railroad Retirement may pay a lower amount.

2009

$85,000 or less  

$85,001 - $128,000

$128,001 or more

$96.40    

$250.50

$308.30

 

Medicare Part B Beneficiaries Who File a Joint Tax Return

Income Ranges

2010

$170,000 or less    

$170,001 - $214,000

$214,001 - $320,000

$320,001 - $428,000

$428,001 or more

$110.50*

$154.70

$221.00

$287.30

$353.60

*Couples who received Medicare Part B in 2009, had income at or below $170,000, and had their premiums withheld from their Social Security or Railroad Retirement may pay a lower amount.

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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

2010

$155

2009

$135

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Medicare Part D

2010 Premium Amounts

The following chart provides the Medicare Part D cost-sharing amounts for enrollees for 2010 based on whether a client is receiving Extra Help.

2010

 

Premium Cost*

Annual Deductible

Co-Insurance Cost

Coverage Gap Costs

Copayments

Standard Benefit

Average is $37.55 per month (varies based on chosen plan)

$310 or less

25% of drug costs between $310 and $2,830

Cap of $6,440

100% of costs between the initial coverage limit based on drug costs between $2,830 and $4,550

5% of drug costs or less once out-of-pocket costs reach $4,550

Extra Help -
Full Subsidy

$0**

$0

None

None

$1.10 - $3.30 income*** < 100% FPG

$2.50 - $6.30 income > 100% FPG for drug costs between $.01 - $6,440

Extra Help -
Partial Subsidy

Sliding Scale Fee

$63

15% of drug costs between $63 and $6,440

None

$2.50 generic/$6.30 brand name for drug costs exceeding $6,440 per year

*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 2010 Amounts in Excess of the 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 residing in a medical institution, nursing facility or ICF/MR whose costs are paid by MA are exempt from copayments.

 

2009 Premium Amounts

The following chart provides the Medicare Part D cost-sharing amounts for the enrollee for 2009 based on whether a client is receiving Extra Help.

2009

 

Premium Cost*

Annual Deductible

Co-Insurance Cost

Coverage Gap Costs

Copayments

Standard Benefit

Average is $28.00 per month (varies based on chosen plan)

$295 or less

25% of drug costs between $295 and $2,700

Cap of $6,153.75

100% of costs between the initial coverage limit based on drug costs between $2,700 and $4,350

5% of drug costs or less once out-of-pocket costs reach $4,350

Extra Help -
Full Subsidy

$0**

$0

None

None

$1.10 - $3.20 income*** < 100% FPG

$2.40 - $6.00 income > 100% FPG for drug costs between $.01 - $6,153.75

Extra Help -
Partial Subsidy

Sliding Scale Fee

$60

15% of drug costs between $60 and $6,153.75

None

$2.40 generic/$6.00 brand name for drug costs exceeding $6,153.75 per year

*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 2009 Amounts in Excess of the 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 residing in a medical institution, nursing facility or ICF/MR whose costs are paid by MA are exempt from copayments.

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