Effective: December 1, 2009 |
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22.55ar4 - Medicare Cost-Sharing Amounts (Archive) |
Archived: April 1, 2010 |
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 |
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) |
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Year |
Days 1 - 20 |
Days 21 - 100 |
2010 |
$0 |
$137.50 |
2009 |
$0 |
$133.50 |
Medicare Part B Beneficiaries Who File an Individual Tax Return (Not Married) |
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Income Ranges |
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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 |
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*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 will continue to pay premiums based on the base rate of $96.40 in 2010. |
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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 |
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) |
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Income Ranges |
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2010 |
$85,000 or less |
$85,001 - $129,000 |
$129,001 or more |
$110.50* |
$287.30 |
$353.60 |
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*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 will continue to pay premiums based on the base rate of $96.40 in 2010. |
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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 |
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Income Ranges |
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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 |
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*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 will continue to pay premiums based on the base rate of $96.40 in 2010. |
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 |
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 |
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|
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 - |
$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 - |
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. |
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 $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 - |
$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 - |
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. |