What are the 2009 figures for Medicare Part D prescription drug plan premiums, deductibles, co-payments, and coverage gaps?

1 answer | Last updated: Nov 08, 2016
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What are the 2009 figures for Medicare Part D prescription drug plan premiums, deductibles, co-payments, and coverage gaps?


Expert Answers

Every year, the premiums, deductibles, co-payments, and coverage gaps change for Medicare Part D prescription drug plans. Here are the figures for 2009:

Medicare Part D premiums. Monthly premiums for Medicare Part D prescription drug plans run from about $10 to $75 per month, depending on the extent of the coverage provided, the insurance company offering the plan, and where the person buying the plan lives. Plans with the broadest coverage and lowest co-payments tend to have the highest premiums. The average cost of a plan is about $30 per month; a few plans have no premium at all.

Medicare Part D deductible. With most plans, the insured person pays an out-of-pocket deductible, which in 2009 is the first $295 of their prescription drug costs for the year. A few plans with high monthly premiums waive some or all of this deductible.

Medicare Part D co-payments. After the yearly deductible is reached, the insured must pay a coinsurance amount of 25 percent of the cost of a covered drug. This comes in the form of a co-payment for each prescription. The exact co-payment dollar amount for any specific prescription depends on the cost of the drug (as negotiated by the particular insurance company who issued the Medicare Part D plan). Also, the co-payment amount may be higher or lower than the standard 25 percent if the plan has placed the specific drug within its tiered payment system of higher and lower price tiers. Part D co-payments continue until the insured's total prescription drug costs for the year reach $2,700.

Medicare Part D coverage gap ("doughnut hole"). Once a person's total prescription drug costs for the year reach $2,700 (combining what the plan pays and what the insured person pays), the plan pays nothing more unless and until the insured person's payments reach what's called the "catastrophic limit" for the year. In 2009, the catastrophic coverage limit is $4,350 in out-of-pocket costs paid by the insured (including what's paid by non-Part D insurance). A few plans pay some of the cost of drugs while the insured is within this coverage gap; those plans tend to have high premiums.

Medicare Part D catastrophic coverage. If the total out-of-pocket amount someone with a Medicare Part D plan pays (including payments by non-Part D insurance) for prescription drugs during the year reaches $4,350, the Medicare Part D plan will again begin to pay a share of the insured's covered prescription drugs. After this point is reached, the plan pays 95 percent of the cost for covered drugs; the insured person is responsible for the remaining 5 percent.