Effective: December 1, 2006 |
|
04.40.20.05ar1 - Medicare Part D Cost Sharing Chart Archive |
Archived: January 1, 2007 |
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: |
$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. |