|
Medicare Part D- Drug Benefits and Costs
|
Medicaid Duals Full Benefit
(Auto Enrolled) |
Medicaid Eligible
QMB, SLMB, ALMB (Auto Enrolled) |
Low-Income Benefit 1 Not Medicaid Eligible (Fill out Application) |
Low-Income Benefit 2 Not Medicaid Eligible (Fill out Application) |
Standard/Basic Benefit
(Pick PDP) |
Income 2005 FPL
|
Below 100% of poverty
$9,570/yr $798/mo
$12,830/yr $1,070/mo
|
Below 135% of poverty
$12,920/yr $1,077/mo
$17,321/yr $1,444/mo
|
Below 135% of poverty
$12,920/yr $1,077/mo
$17,321/yr $1,444/mo
|
Below 150% of poverty
$14,355/yr $1,197/mo
$19,245/yr $1,604/mo |
N/A |
Asset Test
|
State Rules
$2,000
$3,000 |
State Rules
$4,000
$6,000
|
$6,000
$9,000 |
$10,000
$20,000 |
N/A |
Monthly Premium
|
None |
None |
None |
$0-$37/Mo $0-$420/Yr Sliding Scale based on Income |
$37/Mo $420/Yr |
Annual Deductible
|
None |
None |
None |
$50 |
$250 |
Beneficiary Payments Rx costs
|
$1/ Generics $3/ Brand
LTC- $0 |
$2/ Generics $5/ Brand
LTC $2 Generic $5 Brand
|
$2/ Generics $5/ Brand |
After deductible, you pay 15% of the cost of covered drugs |
After meeting the deductible, you pay 25% up to $2,250 in out of pocket expenses. (Medicare pays 75%) |
Initial Coverage (Start of Gap or doughnut hole) |
No Gap in Coverage |
No Gap in Coverage |
No Gap in Coverage |
No Gap in Coverage |
Coverage stops after you have $2,250 in drug expenses |
Coverage Gap
|
No Gap in Coverage |
No Gap in Coverage |
No Gap in Coverage |
No Gap in Coverage |
There is no Coverage for the $2,850 between $2,250 and $5,100 in drug expenses |
Catastrophic Coverage (The out-of-pocket threshold) |
No copay for low-income individuals after total drug expenses reach the out-of-pocket threshold amount ($3,600 in 2006) |
No copay for low-income individuals after total drug expenses reach the out-of-pocket threshold amount ($3,600 in 2006) |
No copay for low-income individuals after total drug expenses reach the out-of-pocket threshold amount ($3,600 in 2006) |
Copay for low-income individuals is reduced after total drug expenses reach out-of-pocket threshold ($3,600 in 2006) |
Coverage begins again after your out-of-pocket spending on Rx drugs reaches $3,600-that's $5,100 in drug expenses |
Copay after Catastrophic Coverage Begins |
|
|
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$2 Generic and $5 Brand |
The greater of $2/ Generic; $5 Brand or 5% (Medicare pays 95%) |
TCOA March 2005