Who is eligible to receive extra help with their prescription drug costs?
Some Medicare beneficiaries are deemed eligible for a subsidy, and do not need to apply or prove that they meet the eligibility criteria. Other beneficiaries need to apply for a low-income subsidy (see Question 8). Beneficiaries who do not meet the income and asset requirements must follow the standard cost-sharing rules or the rules of an equivalent Medicare drug benefit plan (see Table).
Extra financial help is available under the Medicare drug coverage for beneficiaries whose countable income is below 150 percent of the federal poverty level (FPL) with countable resources (or assets) of $11,990 or less for a single person and $23,970 or less for a married couple. These resource limits include $1,500 per person for burial expenses.
Table. Cost-Sharing Under Standard Medicare Drug Benefit Plans (2008)
|
Type of Cost |
Amount Beneficiary Pays of Out-of-Pocket |
Amount Medicare Pays |
Total Costs |
|
Annual Deductible |
$275 |
$0 |
$275 |
|
Co-Insurance Amounts |
25% of the drug cost until the beneficiary has spent $558.75 out-of-pocket on prescription drugs covered by the plan |
75% of drug cost until Medicare has paid $1,676.25 |
$2,235 |
|
Doughnut Hole Costs |
100% of the drug cost until the beneficiary has spent another $3,216.25 out-of-pocket on prescription drugs covered by the plan |
$0 |
$3,216.25 |
|
TOTAL |
Out-of-Pocket:
$4,050
|
Medicare:
$1,676.25
|
Out-of-Pocket and Medicare:
$5,726.25 |
|
Co-Insurance Amounts under Catastrophic Benefits |
Greater of 5% of the drug cost or a co-payment of $2.25 or $5.60 |
Balance of the drug cost |
|
NOTE: The cost-sharing amounts will increase each year.
Source: http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/downloads/PartDAnnouncement2008.pdf
(Back to Medicare Drug Coverage: Extra Help)
