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2009 Medicare Part D Program Information

Below are the details of the 2009 Standard Benefit Model Plan.


CMS Part D 2009 Standard Benefit Model Plan Details

Here are the highlights for the Centers for Medicare and Medicaid Services (CMS) defined Standard Benefit Plans for 2007, 2008 and 2009. This "Standard Benefit Plan" is the minimum allowable plan to be offered. The details of the 2009 plan will not be released until mid-April 2008. As we learn details, they will be added to the highlights and chart below.
  • Initial Deductible:
    from $275 in 2008 to $295 in 2009
  • Initial Coverage Limit:
    from $2,510 in 2008 to $2,700 in 2009
  • Out-of-Pocket Threshold:
    from $4,050 in 2008 to $4,350 in 2009
  • Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit:
    from $2.25 for generic or preferred drug that is a multi-source drug and $5.60 for all other drugs in 2008 to $2.40 for generics and $6.00 for other drugs in 2009
  • Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees:
    from $2.25 for generic or preferred drug that is a multi-source drug and $5.60 for all other drugs in 2008 to $2.40 for generics and $6.00 for other drugs in 2009

Click here to see a comparison of plan parameters for all years since 2006



Medicare Part D Benefit Parameters for Defined Standard Benefit
2006 through 2009 Comparison
Part D Standard Benefit Design Parameters: 2009 2008 2007 2006
Deductible - (after the Deductible is met, Beneficiary pays 25% of covered costs up to total prescription costs meeting the Initial Coverage Limit. $295 $275 $265 $250
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) $2,700 $2,510 $2,400 $2,250
Total Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap - Catastrophic Coverage starts after this point.  $6,153.75   $5,726.25   $5,451.25   $5,100.00 
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)
$4,350



 $ 295.00
$ 601.25
$3453.75
$4350.00
$4,050



 $ 275.00
$ 558.75
$3216.25
$4050.00
$3,850



 $ 265.00
$ 533.75
$3051.25
$3850.00
$3,600



 $ 250.00
$ 500.00
$2850.00
$3600.00
Catastrophic Coverage Benefit:
    Generic/Preferred Multi-Source Drug $2.40 $2.25 $2.15 $2.00
    Other Drugs $6.00 $5.60 $5.35 $5.00
Part D Full Benefit Dual Eligible Parameters: 2009 2008 2007 2006
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 $1.10 $1.05 $1.00 $1.00
            Other $3.20 $3.10 $3.10 $3.00
        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 $2.40 $2.25 $2.15 $2.00
            Other $6.00 $5.60 $5.35 $5.00
        Above Out-of-Pocket Threshold $0.00 $0.00 $0.00 $0.00
Part D Non-Full Benefit Dual Eligible Full Subsidy Parameters: 2009 2008 2007 2006
Resources < $6,290 (individuals) or < $9,440 (couples)*
    Maximum Copayments up to Out-of-Pocket Threshold
        Generic/Preferred Multi-Source Drug $2.40 $2.25 $2.15 $2.00
        Other $6.00 $5.60 $5.35 $5.00
    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 $60.00 $56.00 $53.00 $50.00
    Coinsurance up to Out-of-Pocket Threshold 15% 15% 15% 15%
    Maximum Copayments above Out-of-Pocket Threshold
        Generic/Preferred Multi-Source Drug $2.40 $2.25 $2.15 $2.00
        Other $6.00 $5.60 $5.35 $5.00
Part D Non-Full Benefit Dual Eligible Partial Subsidy Parameters: 2009 2008 2007 2006
    Deductible $60.00 $56.00 $53.00 $50.00
    Coinsurance up to Out-of-Pocket Threshold 15% 15% 15% 15%
    Maximum Copayments above Out-of-Pocket Threshold
        Generic/Preferred Multi-Source Drug $2.40 $2.25 $2.15 $2.00
        Other $6.00 $5.60 $5.35 $5.00
* The actual amount of resources allowable will be updated for contract year 2009.




2009 Low-Income Premium Subsidy Amounts and Other LIS Links

The 2009 low-income premium subsidy amounts have been released by the Centers for Medicare and Medicaid Services (CMS) Click here for a chart showing the 2009 Medicare Part D premium subsidy per CMS region (state).

Also see:




Important Medicare Part D Dates for 2008-2009

  • October 1, 2008:
    Medicare Part D Prescription Drug plan Marketing Activities can begin - At this time you will be able to once again gather information and evaluate the various Part D plan alternatives.
  • Please note, no enrollments may be accepted before November 15, 2008.
  • November 15 to December 31, 2008:
    Annual Coordinated Election Period - Here is your chance to join a Medicare Part D plan for 2009. If you already have a Medicare Part D plan, this is your time to look back over 2008 and make another decision for your 2009 coverage. Should you stay with your existing coverage or make a change? Here is your opportunity to decide. If you make no decision, you will remain in the same plan as you elected in 2008. There is no enrollment required to renew your present coverage. Don't forget the previous years! People who waited until the end of December also waited into January for the arrival of their Welcome Information. Bottom Line: Don't wait until the end of December to make your enrollment decision. (If you do not enroll during this period, your next chance for coverage is January 2010.)
  • January 1, 2009:
    Your 2009 Medicare Part D plan becomes effective and you will be able to begin using your Part D benefits.
  • January 1 to March 31, 2009:
    Coordinating Special Enrollment Period (or SEP) - This special period is available for those people who enrolled into a Medicare Advantage Plan with Prescription Drug coverage (MA-PDs) and now wish to disenroll back to original Medicare coverage and a Prescription Drug Plan. As noted by CMS: "PDPs must accept enrollments for individuals enrolled in a MA-PD plan and who choose to elect Original Medicare during the MA OEP that occurs from January 1, 2009 through March 31, 2009. Since MA rules require these individuals to maintain prescription drug coverage, they MUST enroll in a PDP to accompany Original Medicare. This SEP allows MA-PD enrollees to enroll in a PDP and is limited to 1 enrollment."


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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.