Click here to see a comparison of plan parameters for all years since 2006
Medicare Part D Benefit Parameters for Defined Standard Benefit 2018 through 2022 Comparison |
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Part D Standard Benefit Design Parameters: | 2022 | 2021 | 2020 | 2019 | 2018 | |||||||||||
Deductible - After the Deductible is met, Beneficiary pays 25% of covered costs up to total prescription costs meeting the Initial Coverage Limit. | $480 | $445 | $435 | $415 | $405 | |||||||||||
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) | $4,430 | $4,130 | $4,020 | $3,820 | $3,750 | |||||||||||
Out-of-Pocket Threshold - This is the Total Out-of-Pocket Costs including the Donut Hole. | $7,050 | $6,550 | $6,350 | $5,100 | $5,000 | |||||||||||
Total Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap - Catastrophic Coverage starts after this point. See note (1) below. |
$10,012.50 (1) | $9,313.75 (1) | $9,038.75 (1) | $7,653.75 (1) | $7,508.75 (1) | |||||||||||
Total Estimated Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap Discount (NON-LIS) See note (2). | $10,690.20 plus a 75% discount on all formulary drugs |
$10,048.39 plus a 75% discount on all formulary drugs |
$9,719.38 plus a 75% discount on all formulary drugs |
$8,139.54 plus a 75% brand discount |
$8,417.60 plus a 65% brand discount |
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Catastrophic Coverage Benefit: | ||||||||||||||||
Generic/Preferred Multi-Source Drug (3) | $3.95 (3) | $3.70 (3) | $3.60 (3) | $3.40 (3) | $3.35 (3) | |||||||||||
Other Drugs (3) | $9.85 (3) | $9.20 (3) | $8.95 (3) | $8.50 (3) | $8.35 (3) | |||||||||||
Part D Full Benefit Dual Eligible (FBDE) Parameters: | 2022 | 2021 | 2020 | 2019 | 2018 | |||||||||||
• 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 | $1.35 | $1.30 | $1.30 | $1.25 | $1.25 | |||||||||||
- Other Drugs | $4.00 | $4.00 | $3.90 | $3.80 | $3.70 | |||||||||||
• 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 | $3.95 | $3.70 | $3.60 | $3.40 | $3.35 | |||||||||||
- Other Drugs | $9.85 | $9.20 | $8.95 | $8.50 | $8.35 | |||||||||||
• 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: | 2022 | 2021 | 2020 | 2019 | 2018 | |||||||||||
Eligible for QMB/SLMB/QI, SSI or applied and income at or below 135% FPL and resources ≤ $9,900 (individuals in 2022) or ≤ $15,600 (couples, 2022) (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 | $3.95 | $3.70 | $3.60 | $3.40 | $3.35 | |||||||||||
- Other Drugs | $9.85 | $9.20 | $8.95 | $8.50 | $8.35 | |||||||||||
• Maximum Copay above Out-of-Pocket Threshold | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||||||
Partial Subsidy Parameters: | 2022 | 2021 | 2020 | 2019 | 2018 | |||||||||||
Applied and income below 150% FPL and resources between $15,510 (individual, 2022) or $30,950 (couples, 2022) (category code 4) (4) | ||||||||||||||||
• Deductible | $99.00 | $92.00 | $89.00 | $85.00 | $83.00 | |||||||||||
• Coinsurance up to Out-of-Pocket Threshold | 15% | 15% | 15% | 15% | 15% | |||||||||||
• Maximum Copayments above Out-of-Pocket Threshold | ||||||||||||||||
- Generic / Preferred Multi-Source Drug | $3.95 | $3.70 | $3.60 | $3.40 | $3.35 | |||||||||||
- Other Drugs | $9.85 | $9.20 | $8.95 | $8.50 | $8.35 | |||||||||||
(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 2022, the weighted gap coinsurance factor is 89.1745%. This is based on the 2020 PDEs (91.76% Brands & 8.24% Generics) | ||||||||||||||||
(3) The Catastrophic Coverage is the greater of 5% or the values shown in the chart above. In 2022, beneficiaries will be charged $3.95 for those generic or preferred multisource drugs with a retail price under $79 and 5% for those with a retail price greater than $79. For brand-name drugs, beneficiaries would pay $9.85 for those drugs with a retail price under $197 and 5% for those with a retail price over $197. | ||||||||||||||||
(4) This amount includes the $1,500 per person burial allowance. The resource limit may be updated during contract year 2022. |
Click here to see a comparison of plan parameters for all years since 2006
Click here to see a comparison of plan parameters for all years since 2006
2022 Full Low-Income Subsidy Income Requirements (135% of FPL) | |||
Persons in Family | 48 Contiguous States & D.C. | Alaska | Hawaii |
1 | $18,347 | $22,937 | $21,101 |
2 | $24,719 | $30,902 | $28,431 |
3 | $31,091 | $38,867 | $35,762 |
4 | $37,463 | $46,832 | $43,092 |
5 | $43,835 | $54,797 | $50,423 |
6 | $50,207 | $62,762 | $57,753 |