Medicare Part D Benefit Parameters for Defined Standard Benefit
2006 through 2009 Comparison |
| Part D Standard Benefit Design Parameters: |
2006 |
2007 |
2008 |
2009 |
| Deductible - (after the Deductible is met, Beneficiary pays 25% of covered costs up to total prescription costs meeting the Initial Coverage Limit. |
$250 |
$265 |
$275 |
$295 |
| Initial Coverage Limit - Coverage Gap (Donut Hole) begins at this point. (The Beneficiary pays 100% of their prescription costs up to the Out-of-Pocket Threshold) |
$2,250 |
$2,400 |
$2,510 |
$2,700 |
| Total Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap - Catastrophic Coverage starts after this point. |
$5,100.00 |
$5,451.25 |
$5,726.25 |
$6,153.75 |
Out-of-Pocket Threshold - This is the Total Out-of-Pocket Costs including the Donut Hole.
2009 Example:
$295 (Deductible)
+(($2700-$295)*25%) (Initial Coverage)
+(($6153.75-$2700)*100%) (Cov. Gap)
= $4,350 (Maximum Out-Of-Pocket Cost prior to Catastrophic Coverage - excluding plan premium) |
$3,600
$ 250.00
$ 500.00
$2850.00
$3600.00 |
$3,850
$ 265.00
$ 533.75
$3051.25
$3850.00 |
$4,050
$ 275.00
$ 558.75
$3216.25
$4050.00 |
$4,350
$ 295.00
$ 601.25
$3453.75
$4350.00 |
| Catastrophic Coverage Benefit: |
| Generic/Preferred Multi-Source Drug |
$2.00 |
$2.15 |
$2.25 |
$2.40 |
| Other Drugs |
$5.00 |
$5.35 |
$5.60 |
$6.00 |
| Part D Full Benefit Dual Eligible Parameters: |
2006 |
2007 |
2008 |
2009 |
| Copayments for Institutionalized Beneficiaries |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
| Maximum Copayments for Non-Institutionalized Beneficiaries |
| Up to or at 100% FPL: |
| Up to Out-of-Pocket Threshold |
| Generic/Preferred Multi-Source Drug |
$1.00 |
$1.00 |
$1.05 |
$1.10 |
| Other |
$3.00 |
$3.10 |
$3.10 |
$3.20 |
| Above Out-of-Pocket Threshold |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
| Over 100% FPL: |
| Up to Out-of-Pocket Threshold |
| Generic/Preferred Multi-Source Drug |
$2.00 |
$2.15 |
$2.25 |
$2.40 |
| Other |
$5.00 |
$5.35 |
$5.60 |
$6.00 |
| Above Out-of-Pocket Threshold |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
| Part D Non-Full Benefit Dual Eligible Full Subsidy Parameters: |
2006 |
2007 |
2008 |
2009 |
| Resources < $6,290 (individuals) or < $9,440 (couples)* |
| Maximum Copayments up to Out-of-Pocket Threshold |
| Generic/Preferred Multi-Source Drug |
$2.00 |
$2.15 |
$2.25 |
$2.40 |
| Other |
$5.00 |
$5.35 |
$5.60 |
$6.00 |
| Maximum Copay above Out-of-Pocket Threshold |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
| Resources between $6,290-$10,490 (individuals) or $9,440-$20,970 (couples)* |
| Deductible |
$50.00 |
$53.00 |
$56.00 |
$60.00 |
| Coinsurance up to Out-of-Pocket Threshold |
15% |
15% |
15% |
15% |
| Maximum Copayments above Out-of-Pocket Threshold |
| Generic/Preferred Multi-Source Drug |
$2.00 |
$2.15 |
$2.25 |
$2.40 |
| Other |
$5.00 |
$5.35 |
$5.60 |
$6.00 |
| Part D Non-Full Benefit Dual Eligible Partial Subsidy Parameters: |
2006 |
2007 |
2008 |
2009 |
| Deductible |
$50.00 |
$53.00 |
$56.00 |
$60.00 |
| Coinsurance up to Out-of-Pocket Threshold |
15% |
15% |
15% |
15% |
| Maximum Copayments above Out-of-Pocket Threshold |
| Generic/Preferred Multi-Source Drug |
$2.00 |
$2.15 |
$2.25 |
$2.40 |
| Other |
$5.00 |
$5.35 |
$5.60 |
$6.00 |
| * The actual amount of resources allowable will be updated for contract year 2009. |
