Click here to see a comparison of plan parameters for all years since 2006
Medicare Part D Benefit Parameters for Defined Standard Benefit 2007 through 2011 Comparison |
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Part D Standard Benefit Design Parameters: | 2011 | 2010 | 2009 | 2008 | 2007 |
Deductible - (after the Deductible is met, Beneficiary pays 25% of covered costs up to total prescription costs meeting the Initial Coverage Limit. | $310 | $310 | $295 | $275 | $265 |
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) | $2,840 | $2,830 | $2,700 | $2,510 | $2,400 |
Total Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap - Catastrophic Coverage starts after this point. | $6,447.50 plus a 50% brand discount |
$6,440.00 plus a $250 rebate |
$6,153.75 | $5,726.25 | $5,451.25 |
Out-of-Pocket Threshold - This is the Total Out-of-Pocket Costs including the Donut Hole. 2011 Example: $310 (Deductible) +(($2840-$310)*25%) (Initial Coverage) +(($6447.5-$2840)*100%) (Cov. Gap) = $4,550 (Maximum Out-Of-Pocket Cost prior to Catastrophic Coverage - excluding plan premium) |
$4,550 $310.00 $632.50 $3,607.50 $4,550.00 |
$4,550 $ 310.00 $ 630.00 $3610.00 $4550.00 |
$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 |
Catastrophic Coverage Benefit: | |||||
Generic/Preferred Multi-Source Drug |
$2.50** | $2.50 | $2.40 | $2.25 | $2.15 |
Other Drugs | $6.30** | $6.30 | $6.00 | $5.60 | $5.35 |
Part D Full Benefit Dual Eligible Parameters: | 2011 | 2010* | 2009 | 2008 | 2007 |
Copayments for Institutionalized Beneficiaries | $0.00 | $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 | $1.10 | $1.10 | $1.05 | $1.00 |
Other | $3.30 | $3.30 | $3.20 | $3.10 | $3.10 |
Above Out-of-Pocket Threshold |
$0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Over 100% FPL: | |||||
Up to Out-of-Pocket Threshold | |||||
Generic/Preferred Multi-Source Drug |
$2.50 | $2.50 | $2.40 | $2.25 | $2.15 |
Other | $6.30 | $6.30 | $6.00 | $5.60 | $5.35 |
Above Out-of-Pocket Threshold |
$0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Part D Non-Full Benefit Dual Eligible Full Subsidy Parameters: | 2011 | 2010* | 2009 | 2008 | 2007 |
Resources < $6,600 (individuals) or < $9,910 (couples)* | |||||
Maximum Copayments up to Out-of-Pocket Threshold | |||||
Generic/Preferred Multi-Source Drug |
$2.00 | $2.50 | $2.40 | $2.25 | $2.15 |
Other | $6.30 | $6.30 | $6.00 | $5.60 | $5.35 |
Maximum Copay above Out-of-Pocket Threshold |
$0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Resources between $6,600-$11,010 (individuals) or $9,910-$22,010 (couples)* | |||||
Deductible | $63.00 | $63.00 | $60.00 | $56.00 | $53.00 |
Coinsurance up to Out-of-Pocket Threshold |
15% | 15% | 15% | 15% | 15% |
Maximum Copayments above Out-of-Pocket Threshold | |||||
Generic/Preferred Multi-Source Drug |
$2.00 | $2.50 | $2.40 | $2.25 | $2.15 |
Other | $6.30 | $6.30 | $6.00 | $5.60 | $5.35 |
Part D Non-Full Benefit Dual Eligible Partial Subsidy Parameters: | 2011 | 2010* | 2009 | 2008 | 2007 |
Deductible | $63.00 | $63.00 | $60.00 | $56.00 | $53.00 |
Coinsurance up to Out-of-Pocket Threshold |
15% | 15% | 15% | 15% | 15% |
Maximum Copayments above Out-of-Pocket Threshold | |||||
Generic/Preferred Multi-Source Drug |
$2.50 | $2.50 | $2.40 | $2.25 | $2.15 |
Other | $6.30 | $6.30 | $6.00 | $5.60 | $5.35 |
* The actual amount of resources allowable will be updated for contract year 2011. ** The Catastrophic Coverage is the greater of 5% or the values shown in the chart above. In 2010, beneficiaries would be charged $2.50 for those generic or preferred multisource drugs with a retail price under $50 and 5% for those with a retail price greater than $50. As to Brand drugs, beneficiaries would pay $6.30 for those drugs with a retail price under $130 and 5% for those with a retail price over $130. |
Click here to see a comparison of plan parameters for all years since 2006
The annual percentage increase in average per capita Part D spending -- used to update the deductible, initial coverage limit, and out-of-pocket threshold for the defined standard benefit for 2011 -- is 4.63 percent. The annual percentage increase in the Consumer Price Index -- used to update the 2011 maximum copayments below the out-of-pocket threshold for certain dual eligible enrollees -- is approximately 1.58 percent. CMS revises these percentages to correct calculation errors identified following the release of the Advance Notice."