Medicare Part D 2015 Update

Medicare Part D Benefit Parameters for Defined Standard Benefit 2011 through 2015 Comparison
Part D Standard Benefit Design Parameters:	2015	2014	2013	2012	2011
Deductible - (after the Deductible is met, Beneficiary pays 25% of covered costs up to total prescription costs meeting the Initial Coverage Limit.	$320	$310	$325	$320	$310
Initial Coverage Limit - Coverage Gap (Donut Hole) begins at this point. (The Beneficiary pays 100% of their prescription costs up to the Out-of-Pocket Threshold)	$2,960	$2,850	$2,970	$2,930	$2,840
Total Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap - Catastrophic Coverage starts after this point. See note (1) below.	$6,680.00 (1) plus a 55% brand discount	$6,455.00 (1) plus a 52.50% brand discount	$6,733.75 (1) plus a 52.50% brand discount	$6,657.50 (1) plus a 50% brand discount	$6,447.50 (1) plus a 50% brand discount
Out-of-Pocket Threshold - This is the Total Out-of-Pocket Costs including the Donut Hole. 2015 Example:    $320 (Deductible) +(($2960-$320)*25%) (Initial Coverage) +(($6680.00-$2960)*100%) (Cov. Gap) = $4,700 (Maximum Out-Of-Pocket Cost prior to Catastrophic Coverage - excluding plan premium)	$4,700 $320.00 $660.00 $3,720.00 $4,700.00	$4,550 $310.00 $635.00 $3,605.00 $4,550.00	$4,750 $325.00 $661.25 $3,763.75 $4,750.00	$4,700 $320.00 $652.50 $3,727.50 $4,700.00	$4,550 $310.00 $632.50 $3,607.50 $4,550.00
Total Estimated Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap Discount (NON-LIS) See note (2).	$7,061.76	$6,690.77	$6,954.52	$6,730.39	$6,483.72
Catastrophic Coverage Benefit:
Generic/Preferred    Multi-Source Drug (3)	$2.65 (3)	$2.55 (3)	$2.65 (3)	$2.60 (3)	$2.50 (3)
Other Drugs (3)	$6.60 (3)	$6.35 (3)	$6.60 (3)	$6.50 (3)	$6.30 (3)
Part D Full Benefit Dual Eligible (FBDE) Parameters:	2015	2014	2013	2012	2011
Deductible	$0.00	$0.00	$0.00	$0.00	$0.00
Copayments for    Institutionalized    Beneficiaries	$0.00	$0.00	$0.00	$0.00	$0.00
Maximum Copayments for Non-Institutionalized Beneficiaries
Up to or at 100% FPL:
Up to Out-of-Pocket Threshold
Generic/Preferred       Multi-Source Drug	$1.20	$1.20	$1.15	$1.10	$1.10
Other	$3.60	$3.60	$3.50	$3.30	$3.30
Above Out-of-Pocket      Threshold	$0.00	$0.00	$0.00	$0.00	$0.00
Over 100% FPL:
Up to Out-of-Pocket Threshold
Generic/Preferred       Multi-Source Drug	$2.65	$2.55	$2.65	$2.60	$2.50
Other	$6.60	$6.35	$6.60	$6.50	$6.30
Above Out-of-Pocket      Threshold	$0.00	$0.00	$0.00	$0.00	$0.00
Part D Full Subsidy - Non Full Benefit Dual Eligible Full Subsidy Parameters:	2015	2014	2013	2012	2011
Eligible for QMB/SLMB/QI, SSI or applied and income at or below 135% FPL and resources < $7,160 (individuals) or < $10,750 (couples)***
Deductible	$0.00	$0.00	$0.00	$0.00	$0.00
Maximum Copayments up to Out-of-Pocket Threshold
Generic/Preferred       Multi-Source Drug	$2.60	$2.55	$2.65	$2.60	$2.50
Other	$6.60	$6.35	$6.60	$6.50	$6.30
Maximum Copay above    Out-of-Pocket    Threshold	$0.00	$0.00	$0.00	$0.00	$0.00
Partial Subsidy Parameters:	2015	2014	2013	2012	2011
Applied and income below 150% FPL and resources between $7,161-$13,440 (individuals) or $10,751-$26,860 (couples) (category code 4)***
Deductible	$66.00	$63.00	$66.00	$65.00	$63.00
Coinsurance up to    Out-of-Pocket    Threshold	15%	15%	15%	15%	15%
Maximum Copayments above Out-of-Pocket Threshold
Generic/Preferred       Multi-Source Drug	$2.65	$2.55	$2.65	$2.60	$2.50
Other	$6.60	$6.35	$6.60	$6.50	$6.30
(1) Total Covered Part D Spending at Out-of-Pocket Threshold for Non-Applicable Beneficiaries - Beneficiaries who ARE entitled to an income-related subsidy under section 1860D-14(a) (LIS)
(2) Total Covered Part D Spending at Out-of-Pocket Threshold for Applicable Beneficiaries - Beneficiaries who are NOT entitled to an income-related subsidy under section 1860D-14(a) (NON-LIS) and do receive the coverage gap discount. For 2015, the weighted gap coinsurance factor is 90.693%. This is based on the 2013 PDEs (85.9% Brands & 14.1% Generics)
(3) The Catastrophic Coverage is the greater of 5% or the values shown in the chart above. In 2014, beneficiaries would be charged $2.60 for those generic or preferred multisource drugs with a retail price under $52 and 5% for those with a retail price greater than $52. As to Brand drugs, beneficiaries would pay $6.60 for those drugs with a retail price under $132 and 5% for those with a retail price over $132.
(4) The actual amount of resources allowable may be updated for contract year 2015