Click here to see a comparison of plan parameters for all years since 2006
| Medicare Part D Benefit Parameters for Defined Standard Benefit 2013 through 2017 Comparison |
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| Part D Standard Benefit Design Parameters: | 2017 | 2016 | 2015 | 2014 | 2013 |
| Deductible - (after the Deductible is met, Beneficiary pays 25% of covered costs up to total prescription costs meeting the Initial Coverage Limit. | $400 | $360 | $320 | $310 | $325 |
| 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) | $3,700 | $3,310 | $2,960 | $2,850 | $2,970 |
| Out-of-Pocket Threshold - This is the Total Out-of-Pocket Costs including the Donut Hole. | $4,950 | $4,850 | $4,700 | $4,550 | $4,750 |
| Total Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap - Catastrophic Coverage starts after this point. See note (1) below. |
$7,425.00 (1) | $7,062.50 (1) | $6,680.00 (1) | $6,455.00 (1) | $6,733.75 (1) |
| Total Estimated Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap Discount (NON-LIS) See note (2). | $8,071.16 plus a 60% brand discount |
$7,515.22 plus a 55% brand discount |
$7,061.76 plus a 55% brand discount |
$6,690.77 plus a 52.50% brand discount |
$6,954.52 plus a 52.50% brand discount |
| Average NON-LIS percentage brand and generic drug purchases made during the coverage gap used to estimate the Total Covered Part D OOP threshold for NON-LIS beneficiaries (see above). | Brand: 87.9% Generic: 12.1% |
Brand: 84.6% Generic: 15.4% |
Brand: 85.9% Generic: 14.1% |
Brand: 86.2% Generic: 13.2% |
Brand: 85.6% Generic: 14.4% |
| Catastrophic Coverage Benefit: | |||||
| Generic/Preferred Multi-Source Drug (3) |
$3.30 (3) | $2.95 (3) | $2.65 (3) | $2.55 (3) | $2.65 (3) |
| Other Drugs (3) | $8.25 (3) | $7.40 (3) | $6.60 (3) | $6.35 (3) | $6.60 (3) |
| Part D Full Benefit Dual Eligible (FBDE) Parameters: | 2017 | 2016 | 2015 | 2014 | 2013 |
| Deductible | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 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 |
$1.20 | $1.20 | $1.20 | $1.20 | $1.15 |
| Other | $3.70 | $3.60 | $3.60 | $3.60 | $3.50 |
| 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 |
$3.30 | $2.95 | $2.65 | $2.55 | $2.65 |
| Other | $8.25 | $7.40 | $6.60 | $6.35 | $6.60 |
| Above Out-of-Pocket Threshold |
$0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Part D Full Subsidy - Non Full Benefit Dual Eligible Full Subsidy Parameters: | 2017 | 2016 | 2015 | 2014 | 2013 |
| Eligible for QMB/SLMB/QI, SSI or applied and income at or below 135% FPL and resources ≤ $8,890 (individuals) or ≤ $14,090 (couples) (4) | |||||
| Deductible | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | Maximum Copayments up to Out-of-Pocket Threshold |
| Generic/Preferred Multi-Source Drug |
$3.30 | $2.95 | $2.65 | $2.55 | $2.65 |
| Other | $8.25 | $7.40 | $6.60 | $6.35 | $6.60 |
| Maximum Copay above Out-of-Pocket Threshold |
$0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Partial Subsidy Parameters: | 2017 | 2016 | 2015 | 2014 | 2013 |
| Applied and income below 150% FPL and resources between $8,890-$13,820 (individuals) or $14,090-$27,600 (couples) (category code 4) (4) | |||||
| Deductible | $82.00 | $74.00 | $66.00 | $63.00 | $66.00 |
| Coinsurance up to Out-of-Pocket Threshold |
15% | 15% | 15% | 15% | 15% |
| Maximum Copayments above Out-of-Pocket Threshold | |||||
| Generic/Preferred Multi-Source Drug |
$3.30 | $2.95 | $2.65 | $2.55 | $2.65 |
| Other | $8.25 | $7.40 | $6.60 | $6.35 | $6.60 |
| (1) Total Covered Part D Spending at Out-of-Pocket Threshold for Non-Applicable Beneficiaries - Beneficiaries who ARE entitled to an income-related subsidy under section 1860D-14(a) (LIS) | |||||
| (2) Total Covered Part D Spending at Out-of-Pocket Threshold for Applicable Beneficiaries - Beneficiaries who are NOT entitled to an income-related subsidy under section 1860D-14(a) (NON-LIS) and do receive the coverage gap discount. For 2017, the weighted gap coinsurance factor is 89.95%. This is based on the 2015 PDEs (87.9% Brands & 12.1% Generics) | |||||
| (3) The Catastrophic Coverage is the greater of 5% or the values shown in the chart above. In 2017, beneficiaries will be charged $3.30 for those generic or preferred multisource drugs with a retail price under $66 and 5% for those with a retail price greater than $66. For brand-name drugs, beneficiaries would pay $8.25 for those drugs with a retail price under $165 and 5% for those with a retail price over $165. | |||||
| (4) This amount includes the $1,500 per person burial allowance. The resource limit may be updated during contract year 2017. | |||||
Click here to see a comparison of plan parameters for all years since 2006
| 2017 Full Low-Income Subsidy Income Requirements (135% of FPL) | |||
| Persons in Family | 48 Contiguous States & D.C. | Alaska | Hawaii |
| 1 | $16,281.00 | $20,331.00 | $18,711.00 |
| 2 | $21,924.00 | $27,391.50 | $25,204.50 |
| 3 | $27,567.00 | $34,452.00 | $31,698.00 |
| 4 | $33,210.00 | $41,512.50 | $38,191.50 |
| 5 | $38,853.00 | $48,573.00 | $44,685.00 |
| 6 | $44,496.00 | $55,633.50 | $51,178.50 |