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- Medicare Doctor Copay
- Medicare Copay For Rehab 2019
- Medicare Advantage Copays 2019
- Medicare Deductible 2019
When the 'Medicare and You 2019' was published in October, Medicare was not able to put in the 2019 deductibles and copays, as they had not been approved by Congress at the time of publishing. The standard monthly premium for Medicare Part B enrollees will be $144.60 for 2020, an increase of $9.10 from $135.50 in 2019. The annual deductible for all Medicare Part B beneficiaries is $198 in 2020, an increase of $13 from the annual deductible of $185 in 2019.
Below is a comparison of the Standard Benefit Model Plan parameters as released by The Centers for Medicare and Medicaid Services (CMS) for the plan years 2022 through 2006.Medicare Part D Benefit Parameters for Defined Standard Benefit 2006 through 2022 Comparison | |||||||||||||||||
Part D Standard Benefit Design Parameters: | 2022 | 2021 | 2020 | 2019 | 2018 | 2017 | 2016 | 2015 | 2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 |
Deductible - After the Deductible is met, Beneficiary pays 25% of covered costs up to total prescription costs meeting the Initial Coverage Limit. | $480 | $445 | $435 | $415 | $405 | $400 | $360 | $320 | $310 | $325 | $320 | $310 | $310 | $295 | $275 | $265 | $250 |
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) | $4,430 | $4,130 | $4,020 | $3,820 | $3,750 | $3,700 | $3,310 | $2,960 | $2,850 | $2,970 | $2,930 | $2,840 | $2,830 | $2,700 | $2,510 | $2,400 | $2,250 |
Out-of-Pocket Threshold - This is the Total Out-of-Pocket Costs including the Donut Hole. | $7,050 | $6,550 | $6,350 | $5,100 | $5,000 | $4,950 | $4,850 | $4,700 | $4,550 | $4,750 | $4,700 | $4,550 | $4,550 | $4,350 | $4,050 | $3,850 | $3,600 |
Total Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap - Catastrophic Coverage starts after this point. See note (1) below. | $10,012.50 (1) | $9,313.75 (1) | $9,038.75 (1) | $7,653.75 (1) | $7,508.75 (1) | $7,425.00 (1) | $7,062.50 (1) | $6,680.00 (1) | $6,455.00 (1) | $6,733.75 (1) | $6,657.50 (1) | $6,447.50 (1) | $6,440.00 plus a $250 rebate | $6,153.75 | $5,726.25 | $5,451.25 | $5,100.00 |
Total Estimated Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap Discount (NON-LIS) See note (2). | $10,690.20 plus a 75% discount on all formulary drugs | $10,048.39 plus a 75% discount on all formulary drugs | $9,719.38 plus a 75% discount on all formulary drugs | $8,139.54 plus a 75% brand discount | $8,417.60 plus a 65% brand discount | $8,071.16 plus a 60% brand discount | $7,515.22 plus a 55% brand discount | $7,061.76 plus a 55% brand discount | $6,690.77 plus a 52.50% brand discount | $6,954.52 plus a 52.50% brand discount | $6,730.39 plus a 50% brand discount | $6,483.72 plus a 50% brand discount | |||||
Catastrophic Coverage Benefit: | |||||||||||||||||
Generic/Preferred Multi-Source Drug (3) | $3.95 (3) | $3.70 (3) | $3.60 (3) | $3.40 (3) | $3.35 (3) | $3.30 (3) | $2.95 (3) | $2.65 (3) | $2.55 (3) | $2.65 (3) | $2.60 (3) | $2.50 (3) | $2.50 (3) | $2.40 (3) | $2.25 (3) | $2.15 (3) | $2.00 (3) |
Other Drugs (3) | $9.85 (3) | $9.20 (3) | $8.95 (3) | $8.50 (3) | $8.35 (3) | $8.25 (3) | $7.40 (3) | $6.60 (3) | $6.35 (3) | $6.60 (3) | $6.50 (3) | $6.30 (3) | $6.30 (3) | $6.00 (3) | $5.60 (3) | $5.35 (3) | $5.00 (3) |
Part D Full Benefit Dual Eligible (FBDE) Parameters: | 2022 | 2021 | 2020 | 2019 | 2018 | 2017 | 2016 | 2015 | 2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 |
• Deductible | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
• Copayments for Institutionalized Beneficiaries | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $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 | $1.35 | $1.30 | $1.30 | $1.25 | $1.25 | $1.20 | $1.20 | $1.20 | $1.20 | $1.15 | $1.10 | $1.10 | $1.10 | $1.10 | $1.05 | $1.00 | $1.00 |
- Other Drugs | $4.00 | $4.00 | $3.90 | $3.80 | $3.70 | $3.70 | $3.60 | $3.60 | $3.60 | $3.50 | $3.30 | $3.30 | $3.30 | $3.20 | $3.10 | $3.10 | $3.00 |
• Above Out-of-Pocket Threshold | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
Over 100% FPL: | |||||||||||||||||
• Up to Out-of-Pocket Threshold | |||||||||||||||||
- Generic / Preferred Multi-Source Drug | $3.95 | $3.70 | $3.60 | $3.40 | $3.35 | $3.30 | $2.95 | $2.65 | $2.55 | $2.65 | $2.60 | $2.50 | $2.50 | $2.40 | $2.25 | $2.15 | $2.00 |
- Other Drugs | $9.85 | $9.20 | $8.95 | $8.50 | $8.35 | $8.25 | $7.40 | $6.60 | $6.35 | $6.60 | $6.50 | $6.30 | $6.30 | $6.00 | $5.60 | $5.35 | $5.00 |
• Above Out-of-Pocket Threshold | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Part D Full Subsidy - Non Full Benefit Dual Eligible Full Subsidy Parameters: | 2022 | 2021 | 2020 | 2019 | 2018 | 2017 | 2016 | 2015 | 2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 |
Eligible for QMB/SLMB/QI, SSI or applied and income at or below 135% FPL and resources ≤ $9,470 (individuals in 2021) or ≤ $14,960 (couples, 2021) (4) | |||||||||||||||||
• Deductible | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
• Maximum Copayments up to Out-of-Pocket Threshold | |||||||||||||||||
- Generic / Preferred Multi-Source Drug | $3.95 | $3.70 | $3.60 | $3.40 | $3.35 | $3.30 | $2.95 | $2.65 | $2.55 | $2.65 | $2.60 | $2.50 | $2.50 | $2.40 | $2.25 | $2.15 | $2.00 |
- Other Drugs | $9.85 | $9.20 | $8.95 | $8.50 | $8.35 | $8.25 | $7.40 | $6.60 | $6.35 | $6.60 | $6.50 | $6.30 | $6.30 | $6.00 | $5.60 | $5.35 | $5.00 |
• Maximum Copay above Out-of-Pocket Threshold | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Partial Subsidy Parameters: | 2022 | 2021 | 2020 | 2019 | 2018 | 2017 | 2016 | 2015 | 2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 |
Applied and income below 150% FPL and resources between $14,790 (individual, 2021) or $29,520 (couples, 2021) (category code 4) (4) | |||||||||||||||||
• Deductible | $99.00 | $92.00 | $89.00 | $85.00 | $83.00 | $82.00 | $74.00 | $66.00 | $63.00 | $66.00 | $65.00 | $63.00 | $63.00 | $60.00 | $56.00 | $53.00 | $50.00 |
• Coinsurance up to Out-of-Pocket Threshold | 15% | 15% | 15% | 15% | 15% | 15% | 15% | 15% | 15% | 15% | 15% | 15% | 15% | 15% | 15% | 15% | 15% |
• Maximum Copayments above Out-of-Pocket Threshold | |||||||||||||||||
- Generic / Preferred Multi-Source Drug | $3.95 | $3.70 | $3.60 | $3.40 | $3.35 | $3.30 | $2.95 | $2.65 | $2.55 | $2.65 | $2.60 | $2.50 | $2.50 | $2.40 | $2.25 | $2.15 | $2.00 |
- Other Drugs | $9.85 | $9.20 | $8.95 | $8.50 | $8.35 | $8.25 | $7.40 | $6.60 | $6.35 | $6.60 | $6.50 | $6.30 | $6.30 | $6.00 | $5.60 | $5.35 | $5.00 |
(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 2022, the weighted gap coinsurance factor is 89.1745%. This is based on the 2020 PDEs (91.76% Brands & 8.24% Generics) | |||||||||||||||||
(3) The Catastrophic Coverage is the greater of 5% or the values shown in the chart above. In 2022, beneficiaries will be charged $3.95 for those generic or preferred multisource drugs with a retail price under $79 and 5% for those with a retail price greater than $79. For brand-name drugs, beneficiaries would pay $9.85 for those drugs with a retail price under $197 and 5% for those with a retail price over $197. | |||||||||||||||||
(4) This amount includes the $1,500 per person burial allowance. The resource limit may be updated during contract year 2022. |
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Medicare Doctor Copay
Last week the Centers for Medicare & Medicaid Services released the Medicare premium, deductible and co-pay amounts for 2019. Below are the 2019 cost-sharing amounts.
Part A Premium (For those not automatically enrolled)
- 0-29 qualifying quarters of employment: $437.00
- 30-39 quarters: $240.00
Inpatient Hospital
Medicare Copay For Rehab 2019
- Deductible, Per Spell of Illness: $1,364.00
- Co-pay, Days 1 – 60: $0
- Co-pay, Days 61 – 90: $341.00/day
- Co-pay, Lifetime Reserve Days: $682.00/day
Skilled Nursing Facility
- Co-pay, Days 1 – 20: $0
- Co-pay, Days 21 – 100: $170.50
Standard Monthly Part B Premium
- $135.50 for new enrollees and those not “held harmless”
- While most Medicare recipients will pay the new $135.50 standard monthly premium, an estimated 2 million (3.5%) will pay less because of a 'hold harmless' provision that limits certain beneficiaries' increase in their Part B premium to be no greater than the increase in their Social Security benefits.
Part B Deductible
- $185.00 for all Part B beneficiaries.
Medicare Advantage Copays 2019
Part B Income-Related Premiums
Medicare Deductible 2019
- Income less than or equal to $85,000 ($170,000 /couple): $135.50
- Greater than $85,000 and less than $107,000 ($170,000 – $214,000/couple): $189.60
- Greater than $107,000 and less than or equal to $133,500 ($214,000 – $267,000 /couple): $270.90
- Greater than $133,500 and less than or equal to $160,000 ($267,000 – $320,000/couple): $352.20
- Greater than $160,000 and less than or equal to $500,000 ($320,000 – $750,000/couple): $433.40
- Greater than $500,000 ($750,000/couple): $460.50