Click below for the information on the 2011 Medicare Part D prescription drug plans
https://q1medicare.com/2011

Click below for the latest information on Medicare Part D prescription drug plans in your area
https://PDPFinder.com

Click below for the latest information on Medicare Advantage plans (with and without Part D prescription drug coverage) in your area
https://MAFinder.com

By now you are probably becoming accustomed to your new 2007 Medicare Part D prescription drug plan.  So you may be surprised to hear that the new 2008 Medicare Part D plans have already been designed and submitted to the Centers for Medicare and Medicaid Services (CMS) for approval.  However, details surrounding these newly designed 2008 Medicare Part D plans will not be released until later in 2007.

What do we know about the 2008 Medicare Part D plans?

Each year CMS is required to provide a standard or model Medicare Part D plan and the yet unreleased 2008 Medicare Part D plans must meet or exceed the features of this standard or model CMS Part D plan.

So, although the 2008 CMS model Medicare Part D plan is not an actual prescription drug plan that is offered for sale, the CMS modelPart D plan does give us an idea of the trends for 2008.  Also, some plan providers have offered a duplicate of the CMS Model plan in 2006 & 2007, and may once again in 2008.  Let’s take a look at how the 2008 model plan compares to 2007:

Changes in the Standard or Model CMS Medicare Part D Plan:

First, as a quick review, there are four phases to the standard Medicare Part D coverage.

(1) The Deductible – You pay 100% of prescription costs.
(2) The Initial Coverage – The prescription coverage after the deductible and up to the Doughnut Hole or Coverage Gap.
(3) The Doughnut Hole or Coverage Gap – You pay 100% of your prescription costs (Changed in 2011 with the introduction of the Donut Hole Discount Program).
(4) The Catastrophic Coverage – You pay only very small part of your prescription costs. 


Changes in the Deductible: increased from $265 in 2007 to $275 in 2008

If you have a Medicare Part D plan that follows the 2008 CMS model plan, you will pay the first $275 before your medications are covered by your Medicare Part D benefit.

Changes in the Initial Coverage Limit: increased from $2,400 in 2007 to $2,510 in 2008

The beneficiary with a plan that exactly follows the 2008 CMS model Part D plan will have prescription drug coverage after their deductible ($) up to the point where the retail costs of their covered prescriptions reach a total cost of $.At this point, the Coverage Gap (or Doughnut Hole) begins and unless the beneficiary has a Medicare Part D plan that provides coverage through the Doughnut Hole**, the beneficiary will be responsible for 100% of their prescription costs.The coverage gap continues until the beneficiary enters the area of Catastrophic Coverage, where the costs of medications are greatly reduced (see the section below).

**Please note: Only a very limited number of Medicare Part D plans offered complete Doughnut Hole coverage in 2007.  Most 2007 Part D plans offering Doughnut Hole coverage only included generic medications.

Co-Insurance or Co-Payment for Prescriptions: 25% of the covered Medications

This is the Part D coverage area between your deductible of $275 and up through your Initial Coverage Limit of $2,510, the beneficiary will pay 25% of the costs of their medications – the Part D plan provider will pay the other 75%.

Changes in the Out-of-Pocket Threshold: increased from $3,850 in 2007 to $4,050 in 2008

So when does the 2008 Coverage Gap or Doughnut Hole end?
When a beneficiary has spent a total of $4,050 in actual out of pocket costs, then the beneficiary will exit the Doughnut Hole and enter the Catastrophic Coverage phase.See the example calculation under Out-of-Pocket Threshold in the chart at: https://q1medicare.com/2008.

Changes in the Minimum Cost-Sharing in the Catastrophic Coverage Portion of the Benefit: increased from $2.15 for generics or preferred drugs that are multi-source drugs and $5.35 for all other drugs in 2007 to $2.25 for generics and $5.60 for other drugs in 2008

Again, once in Catastrophic Coverage (after the Doughnut Hole is satisfied), the cost of medications will be reduced to $2.25 for generic prescriptions and $5.60 for other prescriptions.  As noted, these prescription prices come into effect after your total out of pocket costs reach $4,050.

Lastly, here are a few notes on Medicare beneficiaries who are eligible for both Medicare and Medicaid (or Dual-Eligible)

Part D Full Benefit Dual Eligible (Medicare and Medicaid) – Co-payments for Institutionalized Beneficiaries – remains at $0 in 2008

Maximum Co-payments for Non-Institutionalized Full Subsidy Dual Eligible up to or at 100% of the Federal Poverty Level (FPL): increased from $1.00 for generic or preferred drug that is a multi-source drug and $3.10 for all other drugs in 2007 to $1.05 for generics and $3.10 for other drugs in 2008 (the same as in 2007) (The costs falls to $0 when the fully Dual-Eligible beneficiary exceeds the Out -of-Pocket Threshold.)

Maximum Co-payments for Non-Institutionalized Full Subsidy Dual Eligible over 100% of the Federal Poverty Level (FPL): increased from $2.15 for generic or preferred drug that is a multi-source drug and $5.35 for all other drugs in 2007 increased to $2.25 for generics and $5.60 for other drugs in 2008 (The costs falls to $0 when the fully Dual-Eligible beneficiary exceeds the Out-of-Pocket Threshold.)

(Source: Department of Health and Human Services, Centers for Medicare and Medicaid Services – April 2, 2007)

Still need more details or another view?

If you wish to see the details of the CMS Model Medicare Part D Plan as a table or see how 2008 compares to 2006 and 2007, please take a look at : https://q1medicare.com/2008

Making a budget estimate for 2008? Try our 2008 Model Medicare Part D Expense Estimator.

Would you like to estimate your out-of-pocket costs for 2008?  We have a simple online calculator that will let you estimate your total out-of-pocket prescription costs based on the 2008 CMS model Medical Part D plan.  Remember to add the cost of your monthly Part D plan premiums to this number to get an idea of how much you may spend in 2008. https://q1medicare.com/ PartD-PHPPartDCalculator 08MedPartDXphp.php