Medicare Part D | My Medicare Advisor

New for 2015- Medicare Part D Standard Benefit Model Announced

Posted by Allen Heffler 07/24/2014 New for 2015- Medicare Part D Standard Benefit Model Announced Recently Announced by CMS 2015 Medicare Part D Standard Benefit Model Plan Details Below are the highlights for the CMS defined Standard Benefit Plan changes for 2015 compared to 2014. This Standard Benefit Plan is the minimum benefit allowable plan to be offered.

Initial Deductible: For 2015- Increased to $320 (in 2014, it was $310, an increase of $10)
Initial Coverage Limit: For 2015- Increased to $2,960 (in 2014, it was $2,850, an increase of $110)
Out-of-Pocket Threshold:

For 2015- Increased to $4,700 (in 2014, it was $4,550, an increase of $150)

Coverage Gap (donut hole): Starts when you reach your Medicare Part D plan’s initial coverage limit of $2,960 (in 2015) and ends when you spend a true out of pocket total of $4,700 (in 2015.)
NEW FOR 2015! In 2015, Part D enrollees will receive a 55% discount on the total cost of their brand-name drugs purchased while in the donut hole. The 50% discount paid by the brand-name drug manufacturer will still apply to getting out of the donut hole, however the additional 5% paid by your Medicare Part D plan will not count toward your TrOOP. Enrollees will pay a maximum of 65% co-pay on generic drugs purchased while in the coverage gap.
Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit**: will increase to greater of 5% or $2.65 for generic or preferred drug that is a multi-source drug and the greater of 5% or $6.60 for all other drugs in 2015
Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees: will increase to $2.65 for generic or preferred drug that is a multi-source drug and $6.60 for all other drugs in 2015

Part D Standard Benefit Design Parameters:	2015	2014
Deductible – (after the Deductible is met, Beneficiary pays 25% of covered costs up to total prescription costs meeting the Initial Coverage Limit.	$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
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 brand discount of 55%	$6,455.00 (1) plus a brand discount of 52.50%
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
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
Generic/Preferred Multi-Source Drug (3)	$2.65 (3)	$2.55 (3)
Other Drugs (3)	$6.60 (3)	$6.35 (3)
Part D Full Benefit Dual Eligible (FBDE) Parameters:	2015	2014
Deductible	$0.00	$0.00
Copayments for Institutionalized Beneficiaries	$0.00	$0.00
Generic/Preferred Multi-Source Drug	$1.20	$1.20
Other	$3.60	$3.60
Above Out-of-Pocket Threshold	$0.00	$0.00
Generic/Preferred Multi-Source Drug	$2.65	$2.55
Other	$6.60	$6.35
Above Out-of-Pocket Threshold	$0.00	$0.00
Part D Full Subsidy – Non Full Benefit Dual Eligible Full Subsidy Parameters:	2015	2014
Deductible	$0.00	$0.00
Generic/Preferred Multi-Source Drug	$2.60	$2.55
Other	$6.60	$6.35
Maximum Copay above Out-of-Pocket Threshold	$0.00	$0.00
Partial Subsidy Parameters:	2015	2014
Deductible	$66.00	$63.00
Coinsurance up to Out-of-Pocket Threshold	15%	15%
Generic/Preferred Multi-Source Drug	$2.65	$2.55
Other	$6.60	$6.35