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2024-2006 Medicare Part D Standard Benefit Model Plan Parameters

 Below is a comparison of the Standard Benefit Model Plan parameters as released by The Centers for Medicare and Medicaid Services (CMS) for the plan years 2024 through 2006.


Medicare Part D Benefit Parameters for Defined Standard Benefit
2006 through 2024 Comparison
Part D Standard Benefit Design Parameters 2024* 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 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. $545 $505 $480 $445 $435 $415 $405 $400 $360 $320 $310 $325 $320 $310 $310 $295 $275 $265 $250
Initial Coverage Limit - The Coverage Gap (Donut Hole) begins when retail drug cost exceed this value. $5,030 $4,660 $4,430 $4,130 $4,020 $3,820 $3,750 $3,700 $3,310 $2,960 $2,850 $2,970 $2,930 $2,840 $2,830 $2,700 $2,510 $2,400 $2,250
Out-of-Pocket Threshold (OOP threshold) - The Coverage Gap ends when Total Out-of-Pocket (TrOOP) costs exceed this value. $8,000 $7,400 $7,050 $6,550 $6,350 $5,100 $5,000 $4,950 $4,850 $4,700 $4,550 $4,750 $4,700 $4,550 $4,550 $4,350 $4,050 $3,850 $3,600
Total covered Part D drug out-of-pocket spending to exit the Coverage Gap - (LIS). See note (1) below. $11,477.39 $10,516.25 $10,012.50 $9,313.75 $9,038.75 $7,653.75 $7,508.75 $7,425.00 $7,062.50 $6,680.00 $6,455.00 $6,733.75 $6,657.50 $6,447.50 $6,440.00


plus a
$250 rebate

 $6,153.75 $5,726.25 $5,451.25 $5,100.00
Total estimated Part D drug out-of-pocket spending to exit the Coverage Gap - (non-LIS). See note (2) below. $12,447.11

plus a 75% discount on all formulary drugs		 $11,206.28

plus a 75% discount on all formulary drugs		 $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		 $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		 $6,730.39

plus a 50% brand discount		 $6,483.72

plus a 50% brand discount		          
Catastrophic Coverage Benefit: From 2006 through 2023 the Catastrophic Coverage cost-sharing was the greater of 5% or the values shown below.
Beginning in 2024, beneficiary cost-sharing in the Catastrophic Coverage stage of the Medicare Part D coverage will be eliminated - and shown below as not applicable.
Generic/Preferred Multi-Source Drug Not Applicable $4.15 $3.95 $3.70 $3.60 $3.40 $3.35 $3.30 $2.95 $2.65 $2.55 $2.65 $2.60 $2.50 $2.50 $2.40 $2.25 $2.15 $2.00
Other Drugs Not Applicable $10.35 $9.85 $9.20 $8.95 $8.50 $8.35 $8.25 $7.40 $6.60 $6.35 $6.60 $6.50 $6.30 $6.30 $6.00 $5.60 $5.35 $5.00

Parameters for Medicare Beneficiaries qualifying for the Low-Income Subsidy (LIS) (Extra Help) program
Part D Full Benefit Dual Eligible (FBDE) Beneficiaries Parameters See note (3):
2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006
• Deductible $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00
• Copayments for Institutionalized Beneficiaries [category code 3] $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00
• Copayments for Beneficiaries Receiving Home and Community-Based Services [category code 3] see note (4) $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00
Maximum Copayments for Non-Institutionalized Beneficiaries
Up to or at 100% FPL [category code 2]:
• Up to Out-of-Pocket Threshold
- Generic / Preferred Multi-Source Drug $1.55$1.45$1.35$1.30 $1.30$1.25$1.25$1.20 $1.20$1.20$1.20$1.15 $1.10$1.10$1.10$1.10 $1.05$1.00$1.00
- Other Drugs $4.60$4.30$4.00$4.00 $3.90$3.80$3.70$3.70 $3.60$3.60$3.60$3.50 $3.30$3.30$3.30$3.20 $3.10$3.10$3.00
• Above Out-of-Pocket Threshold Not Applicable $0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00
Between 100% and 150% FPL [category code 1]:
• Up to Out-of-Pocket Threshold
- Generic / Preferred Multi-Source Drug $4.50$4.15$3.95$3.70 $3.60$3.40$3.35$3.30 $2.95$2.65$2.55$2.65 $2.60$2.50$2.50$2.40 $2.25$2.15$2.00
- Other Drugs $11.20$10.35$9.85$9.20 $8.95$8.50$8.35$8.25 $7.40$6.60$6.35$6.60 $6.50$6.30$6.30$6.00 $5.60$5.35$5.00
• Above Out-of-Pocket Threshold Not Applicable $0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00
Part D Full-Subsidy - Non-FBDE Beneficiary Parameters:
2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006
Applied or eligible for QMB/SLMB/QI or SSI, income at or below 135% FPL 2023 and before or at or below 150% FPL for 2024 and beyond and resources ≤ $10,590 (individuals in 2023) or ≤ $16,630 (couples, 2023) [category code 1] see note (5) See resources for prior years.
• Deductible $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00
• Maximum Copayments up to Out-of-Pocket Threshold
- Generic / Preferred Multi-Source Drug $4.50$4.15$3.95$3.70 $3.60$3.40$3.35$3.30 $2.95$2.65$2.55$2.65 $2.60$2.50$2.50$2.40 $2.25$2.15$2.00
- Other Drugs $11.20$10.35$9.85$9.20 $8.95$8.50$8.35$8.25 $7.40$6.60$6.35$6.60 $6.50$6.30$6.30$6.00 $5.60$5.35$5.00
• Maximum Copay above Out-of-Pocket Threshold Not Applicable $0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00$0.00 $0.00$0.00$0.00
Partial-Subsidy Parameters (Partial-Subsidy category becomes Full-Subsidy LIS beginning January 1, 2024):
2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006
Prior to 2024, Partial-LIS includes beneficiaries who have applied and have income below 150% FPL and resources between $16,660 (individual, 2023) or $33,240 (couples, 2023) [category code 4] (5) See resources for prior years.
• Deductible Not Applicable $104.00$99.00$92.00$89.00 $85.00$83.00$82.00$74.00 $66.00$63.00$66.00$65.00 $63.00$63.00$60.00$56.00 $53.00$50.00
• Coinsurance up to Out-of-Pocket Threshold Not Applicable 15%15%15%15% 15%15%15%15% 15%15%15%15% 15%15%15%15% 15%15%
• Maximum Copayments above Out-of-Pocket Threshold
- Generic / Preferred Multi-Source Drug Not Applicable $4.15$3.95$3.70$3.60 $3.40$3.35$3.30$2.95 $2.65$2.55$2.65$2.60 $2.50$2.50$2.40$2.25 $2.15$2.00
- Other Drugs Not Applicable $10.35$9.85$9.20 $8.95$8.50$8.35$8.25 $7.40$6.60$6.35$6.60 $6.50$6.30$6.30$6.00 $5.60$5.35$5.00
*These parameters reflect additional plan coverage required for covered insulin products under section 1860D-2(b)(9) of the Act, as added by section 11406 of the IRA, and ACIP-recommended vaccines under section 1860D-2(b)(8) of the Act, as added by section 11401 of the IRA.
(1) For a beneficiary who is not considered an "applicable beneficiary" (i.e. LIS-eligible), as defined at section 1860D-14A(g)(1) of the Social Security Act, and is not eligible for the Medicare Coverage Gap Discount Program, this is the amount of total drug spending required to reach the OOP threshold in the defined standard benefit. Medicare notes, that in 2024, "There is a 7 percent adjustment for the estimated total covered Part D spending at catastrophic for non-applicable beneficiaries, because beneficiaries take a longer time to reach the catastrophic phase threshold when they pay less cost sharing for insulins and vaccines (no more than $35 copay per month's supply of insulin and $0 copay on ACIP-recommended adult vaccines) under the 2024 defined standard benefit."
(2) For a beneficiary who is an "applicable beneficiary" (non-LIS), as defined at section 1860D-14A(g)(1) of the Act, and is eligible for the Medicare Coverage Gap Discount Program, this is the estimated average amount of total drug spending required to reach the OOP threshold in the defined standard benefit. Medicare notes, that in 2024, "there is a 9 percent adjustment for the estimated total covered Part D spending at catastrophic for applicable beneficiaries, because beneficiaries take a longer time to reach the catastrophic phase threshold when they pay less cost sharing for insulins and vaccines (no more than $35 copay per month's supply of insulin and $0 copay on ACIP-recommended adult vaccines) under the 2024 defined standard benefit".
(3) The LIS eligibility categories and corresponding cost-sharing benefits are sometimes referred to using category codes as follows:
  • Category Code 1 – Non-institutionalized FBDE beneficiaries with incomes between 100% and 150% of FPL (beginning in CY 2024) and full-subsidy-non-FBDE beneficiaries. Note that LIS beneficiaries that would previously fall into category code 4 fall into category code 1 beginning in CY 2024 – see note for category code 4 below.
  • Category Code 2 – Non-institutionalized FBDE beneficiaries with incomes up to 100% of the FPL.
  • Category Code 3 – FBDE beneficiaries who are institutionalized or would be institutionalized if they were not receiving home and community-based services
  • Category Code 4 – Partial subsidy beneficiaries through CY 2023. As described in Section C2 above, beneficiaries with incomes between 135 percent and 150 percent of the FPL, who meet the resource standards under either of sections 1860D-14(a)(3)(D) or (E) of the Act, and who would have been eligible for the partial LIS benefit absent the enactment of the IRA, will be eligible for the full LIS benefit. These category 4 beneficiaries will now have the same Part D benefit parameters as beneficiaries in category 1 of the LIS. Category 2 and 3 of the LIS remain unchanged.
(4) Per section 1860D-14(a)(1)(D)(i) of the Act, full-benefit dually eligible beneficiaries who are receiving home and community-based services qualify for zero cost sharing if the individuals (or couple) would have been institutionalized otherwise.
(5) The resource limits for CY 2024 will be provided via the annual HPMS memo entitled "2024 Resource and Cost-Sharing Limits for Low-Income Subsidy (LIS)" that is expected to be released during the usual timeframe after the September 2023 CPI has been made available by the Bureau of Labor Statistics. Additionally, these amounts include $1,500 per person for burial expenses. Also, beneficiaries that would have been eligible for the partial LIS benefit had the IRA not been enacted will be eligible for the full LIS benefit if they meet either of the resource standard described at sections 1860D-14(a)(3)(D) or (E) of the Act.







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