Standard Part D Plan

In addition to your monthly premium the 2012 costs for Part D coverage are:

•  An initial $320 deductible.

• After meeting the deductible, the beneficiary pays 25 percent of the cost of a covered prescription drugs, until $2,930 in total drug cost is reached.  This is called the initial coverage limit.

• Once the initial coverage limit is reached, the beneficiary falls in the Coverage Gap. Historically, the member would have had to pay the full cost of drugs until reaching a total out-of-pocket of $4,700 (in 2012)-this includes the costs of the deductible and coninsurance as well as costs incurred during the gap.  However, in 2011, CMS introduced an imporvement to this program in that brand coverage during the Coverage Gap would be 50% subsidized by the pharmaceutical manufacturer of the particular drug.  There are increases in that 50% coverage that phase in gradually over the course of the next ten years and by the year 2020, the 50% subsidy will have increased to 75%.

• Once you have reached the out-of-pocket maximum, you qualify for "Catastrophic Coverage" and will pay $2.60 for a generic drug and $6.50 for other drugs, or a flat 14 percent co-insurance, whichever is greater.

• These thresholds, the deductible, initial coverage limit, out of pocket maximums, and the catastrophic coverage are determined by CMS (Center for Medicare and Medicaid) and may change from year to year.

• Other LIS Parameter Changes

  Partial deductible - $65

  Generic drug copay- $2.60

  Brand drug copay- $6.50