Medicare Cost Sharing Amounts (Archive)

This section lists Medicare cost sharing amounts.

Medicare Part A.

Medicare Part B.

Medicare Part D.

2011 Cost Sharing Amounts.

2010 Cost Sharing Amounts.

 

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Medicare Part A

The following charts provide the Medicare Part A cost sharing amounts.

Premium - Medicare Part A

(paid monthly)

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)

Year

Days 1 - 20
(per day)

Days 21 - 100
(per day)

2011

$0

$141.50

2010

$0

$137.50

 

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Medicare Part B

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 enrolleeā€™s income and tax filing status. Send a SVES query to determine the amount of the Part B premium for which an enrollee is responsible.

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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

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Medicare Part D

2011 Premium Amounts

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

 

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 -
Full Subsidy

$0**

$0

None

None

$1.10 generic drugs; $3.30 brand name drugs***

Extra Help -
Partial Subsidy

$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.

 

2010 Premium Amounts

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

 

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 -
Full Subsidy

$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 -
Partial Subsidy

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.

 

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