Medicare D Cost-Sharing Changes

Medicare Part D monthly premiums and cost sharing are changing in 2009.

There are a total of 47 Part D plans available in 2009 in Massachusetts. The lowest premium plan is $19.40 (First Health Part D-Secure); the highest premium plan is $111.30 (Aetna Medicare RX Premier)

Cost Sharing Changes

• The standard deductible will increase from $275to $295.

• The "donut hole" begins after expenses of $2,700 , up from $2,510 last year. This is the amount that members and the plan spend before the donut hole begins. Members pay 100% out- of- pocket when they are in the donut hole (unless they also have Health Safety Net, Prescription Advantage, or another program to help with their prescription costs in the donut hole). In Massachusetts, only 12 Part D plans have some type of coverage in the donut hole.

• Total out-of-pocket threshold will increase from$4,050 last year to $4,350. Out-of- pocket costs include co-payments, coinsurance and deductibles but NOT premiums. Once members spend $4,350 out - of - pocket for the year, the "donut hole" ends and they only pay a small co-payment. If individuals have Health Safety Net in the donut hole, they just pay HSN Rx copays for the rest of the year.

Extra Help or Low Income Subsidy

Individuals who have limited income and resources qualify for “Extra Help” from Medicare to help pay for their prescription drug costs. Some individuals automatically qualify for “Extra Help” and some have to apply.

Individuals automatically qualify for Extra Help if they

• Are eligible for both Medicare and Medicaid (full dual),
• Get help from their State Medicaid Programs to pay their Medicare premiums, or
• Get Supplemental Security Income benefits

Individuals with income up to 150% FPL ($15,600 for individual; $21,000 for a couple in 2008) and have limited resources ($12,510 for individual; $25,010 for a couple), but who do not automatically qualify for “Extra Help” can apply through Social Security, by calling 1-800-772-1213 or by visiting www.socialsecurity.gov.

-Adapted from “Medicare Part D update -2009”, from Pragya Rizal, Assistant manager, Partners HealthCare Public Payer Policy and Operations, November 06, 2008.

11/08