Medicare Part D Cost Sharing Chart (Archive)

This chart provides basic information regarding cost sharing for standard Medicare Part D benefits and for those people receiving subsidies through Extra Help. See Medicare Part D for more information.

 

Standard Benefit

Full Subsidy

Partial Subsidy

Income

n/a

At or Below 135%

Above 135% FPG and at or below 150% FPG

Asset Limit

n/a

$6000 Individuals

$9000 Married Couple

$10,000 Individuals

$20,000 Married Couple

Premium Cost

2006:
$37/month approximately

$0 if enrolled in a benchmark Medicare Part D plan.

Clients not enrolled in a benchmark Medicare Part D plan are responsible for premium amounts above the standard premium cost.

Sliding Scale Fee

Annual Deductible

2006: $250

None

$50

Coinsurance Cost

25% of drug costs between $250-$2250 with a $500 cap

None

15% of drug costs between $50 - $5100

Coverage Gap Costs

100% of costs between $2251 and $2850

None

 

Copayments

5% of drug costs once out-of-pocket costs reach $3600.

$1 - $5 based on income.  

Once drug costs reach $5100 in a year, copayments eliminated.

MA enrollees residing in a medical institution, nursing home or ICF-MR and whose costs are paid by MA are exempt from copayments.

Reduced for drug costs exceeding $5100 per year.

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