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What are the Base and Supplemental premiums shown in the coverage details of the Q1Medicare Medicare Advantage and Part D plan search tools?

Your monthly Medicare Part D premium can be broken into two parts: the Basic and Supplemental Premiums. 

Although the “total premium” is important to most people considering a Medicare Advantage plan or Medicare Part D plan, we provide the Base Premium and Supplemental Premium information within our Medicare Part D Plan Finder (https://PDP-Finder.com) and Medicare Advantage Plan Finder (https://MA-Finder.com).

The Base and Supplemental Premium information can be used by Medicare beneficiaries to understand how much they will pay per month for a Medicare Part D plan if they are eligible for the full 100%  Low-Income Subsidy (LIS).  Likewise, the Plan Finders show a table listing the monthly premiums for people who are only 75% or 50% or 25% eligible for LIS or Extra Help (based on their income or financial resources).

The Base and Supplemental Medicare Part D Premium and Extra Help

A person who is qualified for full Extra Help or LIS benefits will pay either no Medicare plan premium ($0 depending on the plan) or the person will pay only a portion of the “full premium” that is approximately above the state's Benchmark $0 LIS Premium.  You can see more about a state’s 2021 benchmark premium in our article "2021 State Low-Income Subsidy Benchmark Premium Amounts - with a comparison of benchmark changes since 2006" here:  https://Q1News.com/832.html.

Example:  Your Medicare Part D premium when qualified for 100% LIS

If you qualify for 100% of the LIS subsidy, and you have chosen to enroll into a Medicare Part D prescription drug plan that does not qualify for your state's Low-Income Subsidy $0 monthly premium, and you are responsible for a portion of your monthly premium that is above the state's benchmark premium.

For example, the 2020 Florida $0 LIS Benchmark Premium is $28.47 and if you are qualified for full Extra Help and enrolled in a "basic" Medicare Part D plan with a premium below (or slightly over) the benchmark, you would pay a $0 premium.  So if you chose the 2020 SilverScript Choice (PDP) Medicare Part D plan that has a $25.20 premium, you would pay a $0 premium.

However, in the same situation, if you enrolled into the 2020 Humana Basic Rx Plan (PDP) that has a $40 premium, you would pay $11.50 per month premium (the $40 premium - the $28.47 benchmark premium).

Example:  Your Medicare Part D premium with less than 100% LIS

If you no longer qualify for full Extra Help Benefits (less than 100%), you may be paying a higher portion of your Medicare Part D plan's premium -  even when the Medicare Part D prescription drug plan qualifies for the $0 monthly Low-Income Subsidy premium.

Using the same above example of the Florida 2020 SilverScript Choice (PDP) Medicare Part D plan that has a $25.20 premium, you would pay a $0 premium with full (100%) Extra Help benefits.  But, if you were eligible for only partial Extra Help benefits, you would pay a higher premium (although still less than the full $25.20 premium).  In our example, if you qualified for 50% Extra Help, you would pay a premium of $12.60.

Part D plan premium when not meeting the LIS $0 premium

Example:  Paying the premium balance when your chosen Medicare Part D premium is well above the state benchmark

For example, if you qualify for full Extra Help benefits, and your state has a LIS $0 premium benchmark of $28.50, - and you wish to join a Medicare Part D plan with a premium of $58– you will not pay the full $58 premium with your LIS status, but instead, you will pay only a portion of the total premium.

In this example, let us assume that, of the $58 total premium, $51 is the base premium and this base premium is over the state’s $29 benchmark premium – meaning you pay $29.50.  So if you receive 100% Extra Help (or are Medicare/Medicaid eligible), you will pay the portion of the Base Premium over the benchmark (the amount over the base premium that is not covered by the state benchmark premium + the supplemental premium) or $51 base premium - $28.50 benchmark + $7 supplemental = $29.50 premium with 100% LIS eligibility.

Part D plan premium showing basic and supplemental premiums for determining the LIS premium

More about Base and Supplemental premiums

Medicare notes that:
Part D Total Premium: The Part D Total Premium is the sum of the Basic and Supplemental Premiums.  Note: the Part D Total Premium is net of any Part A/B rebates applied to "buy down" the drug premium for Medicare Advantage plans; for some plans the total premium may be lower than the sum of the basic and supplemental premiums due to negative basic or supplemental premiums.

Part D Basic Premium:  The Part D Basic Premium covers the basic prescription benefit only and does not cover enhanced drug benefits, medical benefits, or hospital benefits.  Note: the Part D Basic Premium is net of any Part A/B rebates applied to "buy down" the drug premium for Medicare Advantage plans.  Beneficiaries are also responsible for their Part B premium and any premiums for Medigap coverage to meet their individual needs.

Part D Supplemental Premium:  The Part D Supplemental Premium covers any enhanced benefits that may be offered by a plan above and beyond the basic (standard) Part D benefit.  These benefits may include extra coverage in the coverage gap, lower copayments than the standard benefit, coverage of non-Part D drugs.  Note: the Part D Supplemental Premium is net of any Part A/B rebates applied to "buy down" the drug premium for Medicare Advantage plans.”

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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.