A Medicare beneficiary who does not qualify for any level of Extra Help from Medicare will pay the following costs for a standard Part D Plan in 2022:
- The plan’s monthly premium (the national Part D base beneficiary premium will be $33.37);
- An annual deductible of $480;
- During the initial coverage period, a 25% co-pay for each covered prescription until the person’s total drug costs reach $4,430;
- After the initial coverage period, a person will continue to pay 25% of the cost of both brand-name and generic drugs (plus a small dispensing fee) until the consumer’s total out-of-pocket expenses reach $7,050; and
- During the catastrophic coverage period, a co-pay of $3.95 for generics and $9.85 for brand name drugs, or a 5% co-pay, whichever is greater, for the rest of the year.
Part D Cost for Those Receiving Extra Help from Medicare: Anyone who qualifies for the full Extra Help from Medicare will have the following costs in 2022. This includes all dual eligibles who have Medicare and who receive any benefit from Medicaid:
- $0 premium (as long as she enrolls in a Part D plan that provides standard benefits and charges a premium below the 2022 Extra Help Benchmark amount of $40.74)
- Small co-pays for their prescription medications:
- $1.35/generics and $4.00/ brand names (if income is less than 100% FPL) or
- $3.95/generics and $9.85/ brand names (if income is above 100% FPL) or
- $0 if someone is on Medicare and receiving Medicaid long term care services in a nursing home or through a Home and Community-Based Services Waiver program
Those beneficiaries who qualify for partial Extra Help in 2022 will pay the following costs:
- A portion of their Part D plan monthly premium depending on the amount of their Extra Help;
- A deductible no higher than $99;
- 15% co-pays on all of their medications until they reach total out-of-pocket expenses of $7,050;
- During the catastrophic coverage period, co-pays of $3.95/generics and $9.85/name brands for the rest of the year.
Individuals getting Extra Help in 2021 will get a written notice if there is going to be a change to their Extra Help status next year or if their Extra Help eligibility is being reviewed. Here's a link to these mailings and others that Medicare beneficiaries are receiving this fall.