Medicare Part D—2010 Information
The Medicare Part D program utilizes an annual bidding process, whereby plans submit a bid each June outlining their plans for the following year. Therefore, elements of the Part D plans can and will change from year to year. This can include changes to the formulary, plan design, premiums, copays, and other plan elements. Each plan is required to mail out a notice in October that outlines any changes to the plan. Patients are encouraged to look closely at this document and evaluate if their current plan still fits their health care needs.
In addition, the standard benefit design and low-income cost-sharing levels, as set by the government, also change each year. Below please find the new information for the 2010 plan year.
Patient Responsibility Standard Benefit Design—2010:
Deductible Phase (Drug Spend: $0-$310)
Low-Income Subsidy (LIS) Cost-Sharing Levels 2009:
Patient pays 100% = $310
Initial Coverage Phase (Drug Spend: $310-$2,830)
Patient pays 25% = $630
Coverage Gap (Drug Spend: $2,830-$6,440)
Patient pays 100% = $3,610
Catastrophic Coverage (Drug Spend >$6,440)
Patient pays ~5%
Full Benefit Dual Eligible Premium Deductible Co-Pays Up to or at 100% FPL $0 $0 $1.10 generic
$3.30 brand/single-sourceAbove 100% FPL $0 $0 $2.50 generic
$6.30 brand/single-sourceInstitutionalized Beneficiary $0 $0 $0
LIS Recipient (Full Subsidy) Premium Deductible Co-Pays Income <135% 100% FPL and
limited resources*$0 $0 $2.50 generic
$6.30 brand/single-source
LIS Recipient (Partial Subsidy) Premium Deductible Co-Pays Income 135%-150% 100% FPL
and limited resources*Sliding $63 15% cost-sharing up to catastrophic coverage
In catastrophic coverage: $2.50 generic
$6.30 brand/singles
Important Medicare Deadlines:
November 15-December 31, 2009 (Annual Enrollment Period)
During this time, your patients can choose to join or switch Medicare prescription drug plans for an effective date of January 1, 2009.
January 1, 2010
If patients enrolled between November 15 and December 31, 2008, their coverage begins today!
January 1-March 31, 2010 (Open Enrollment Period)
If your patients have Medicare prescription drug coverage through a Medicare Advantage or Medicare prescription drug plan, they can switch to a different plan one time only during this period.
April 1-December 31, 2010 (Special Enrollment Period)
During this time, patients can only switch or join plans if they qualify under a Special Enrollment Period such as those listed below:
- Eligible for both Medicare and Medicaid
- About to turn 65 years old
- Moving to a different coverage area