Effective: December 1, 2008 |
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22.55ar3 - Medicare Cost-Sharing Amounts (Archive) |
Archived: December 1, 2009 |
This section lists Medicare cost-sharing amounts.
The following charts provide the Medicare Part A cost-sharing amounts.
Premium - Medicare Part A (paid monthly) |
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Year |
People with 30-39 quarters of Medicare-covered employment |
People with less than 30 quarters of Medicare-covered employment |
2009 |
$244 |
$443 |
2008 |
$233 |
$423 |
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 |
2009 |
$1,068 |
2008 |
$1,024 |
Skilled Nursing Facility Coinsurance - Medicare Part A (per benefit period) |
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Year |
Days 1 - 20 |
Days 21 - 100 |
2009 |
$0 |
$133.50 |
2008 |
$0 |
$128 |
Individual Tax Return - No Spouse - Medicare Part B |
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Income Ranges |
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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 |
|
2008 |
$82,000 or less |
$82,000.01 - $102,000 |
$102,000.01 - $153,000 |
$153,000.01 - $205,000 |
$205,000.01 or more |
$96.40 |
$122.20 |
$160.90 |
$199.70 |
$238.40 |
Individual Tax Return - Spouse* - Medicare Part B (*use these figures if person is filing separately from spouse or |
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Income Ranges |
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2009 |
$85,000 or less |
$85,001 - $128,000 |
$128,001 or more |
$96.40 |
$250.50 |
$308.30 |
|
2008 |
$82,000 or less |
$82,000.01 - $123,000 |
$123,000.01 or more |
$96.40 |
$199.70 |
$238.40 |
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 |
2009 |
$135 |
2008 |
$135 |
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 |
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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 $2700 Cap of $6153.75 |
100% of costs between the initial coverage limit based on drug costs between $2700 and $4350 |
5% of drug costs or less once out-of-pocket costs reach $4350 |
Extra Help - |
$0** |
$0 |
None |
None |
$1.10 - $3.20 income*** < 100% FPG $2.40 - $6.00 income > 100% FPG for drug costs between $.01 - $6153.75 |
Extra Help - |
Sliding Scale Fee |
$60 |
15% of drug costs between $60 and $6153.75 |
None |
$2.40 generic/$6.00 brand name for drug costs exceeding $6153.75 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 2008 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. |
2008 Premium Amounts
The following chart provides the Medicare Part D cost-sharing amounts for the enrollee for 2008 based on whether a client is receiving Extra Help.
2008 |
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Premium Cost* |
Annual Deductible |
Co-Insurance Cost |
Coverage Gap Costs |
Copayments |
Standard Benefit |
Average is $30.61 per month (varies based on chosen plan) |
$275 or less |
25% of drug costs between $275 and $2510 Cap of $5726.25 |
100% of costs between the initial coverage limit based on drug costs between $2510 and $4050 |
5% of drug costs or less once out-of-pocket costs reach $4050 |
Extra Help - |
$0** |
$0 |
None |
None |
$1.05 - $5.60 based on income*** Cap drug costs of $5726.25 |
Extra Help - |
Sliding Scale Fee |
$56 |
15% of drug costs between $56 and $5726.25 |
None |
$2.25 generic/$5.60 brand name for drug costs exceeding $5726.25 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 2008 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. |