Appendix C

Medicare Cost Sharing Amounts

This appendix provides cost sharing amounts for Medicare.

Medicare Part A Cost Sharing Amounts

Cost Type

2025

2026

Premium

Send SVES

Send SVES

Deductible

$1,676

$1,716

Hospital Coinsurance days 61-90

$419

$429

Hospital Coinsurance days 91-150

$838

$858

Skilled Nursing Facility Coinsurance days 1-20

$0

$0

Skilled Nursing Facility Coinsurance days 21-100

$209.50

$214.50

Medicare Part B Cost Sharing Amounts

Cost Type

2025

2026

All Other Premium Amounts

Send SVES

Send SVES

Deductible

$257

$283

MSHO and SNBC plans that will pay the portion listed of the Medicare Part B Premium

None

None

Medicare Part D Cost Sharing Amounts

For information about which Medicare Part D plans in Minnesota are benchmark plans, refer to the Resources section in ONEsource for the Amounts in Excess of Medicare Part D Benchmark to Apply as Medical Expense document. The document also provides the amount a person pays out of pocket for non-benchmark plans.

Standard Benefit Information

Cost Type

2025

2026

Premium

Varies

Varies

Annual Deductible

$590

$615

Coinsurance Costs

 $2,000 annual cap on all covered drugs

 $2,100 annual cap on all covered drugs

Coverage Gap Costs

  N/A

  N/A

Copayments

  • $4.80 generic drugs

  • $12.15 brand name drugs

  • $5.10 generic drugs

  • $12.65 brand name drugs

Extra Help Full Subsidy Information

Cost Type

2025

2026

Premium

$0

$0

Annual Deductible

$0

$0

Coinsurance Costs

None

None

Coverage Gap Costs

None

None

Copayments

  ≤ 100% FPG

  • $1.60 generic drugs

  • $4.90 brand name drugs

  ≤100% FPG

  • $1.60 generic drugs

  • $4.90 brand name drugs