Effective: December 1, 2010 |
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22.55ar6 - Medicare Cost Sharing Amounts (Archive) |
Archived: January 1, 2012 |
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 |
2011 |
$248 |
$450 |
2010 |
$254 |
$461 |
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 |
2011 |
$1,132 |
2010 |
$1,100 |
Skilled Nursing Facility Coinsurance - Medicare Part A (per benefit period) |
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Year |
Days 1 - 20 |
Days 21 - 100 |
2011 |
$0 |
$141.50 |
2010 |
$0 |
$137.50 |
Medicare Part B amounts vary by enrollee. The amount of the Part B premium depends upon when the enrollee first became eligible for Medicare Part B, the enrolleeās income and tax filing status. Send a SVES query to determine the amount of the Part B premium for which an enrollee is responsible.
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 |
2011 |
$162 |
2010 |
$155 |
The following chart provides the Medicare Part D cost sharing amounts for enrollees for 2011 based on whether or not a client is receiving Extra Help.
2011 |
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|
Premium Cost* |
Annual Deductible |
Co-Insurance Cost |
Coverage Gap Costs |
Copayments |
Standard Benefit |
$32.34 |
$310 |
25% of drug costs between $310.01 and $2,840 Cap of $6,447.50 |
50% discount on Brand name drugs; 7% discount on generic drugs between $2,840 and $6,447.50 |
$2.50 generic drugs, $6.30 brand name drugs |
Extra Help - |
$0** |
$0 |
None |
None |
$1.10 generic drugs; $3.30 brand name drugs*** |
Extra Help - |
$0 |
$63 |
None |
None |
$2.50 generic drugs; $6.30 brand name drugs |
*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 2011 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/DD whose costs are paid by MA are exempt from copayments. |
Note: New in 2011 - Beneficiaries who have higher incomes and exceed the same thresholds that apply to the Part B premium, will pay a monthly Part D income related adjustment amount. The beneficiary will pay the monthly premium to the Plan and then pay the income-related adjustment to Medicare.
Minnesota 2011 Benchmark Amount: $37.55.
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/DD whose costs are paid by MA are exempt from copayments. |