Premiums

PREMIUMS

Premiums are monthly fees that a plan charges for the prescription drug coverage.

If I qualify for extra help, will my premium be covered?

If you are a dual eligible and your plan's premium is at or below the regional benchmark, your full premium will be covered. If your plan's premium is above the benchmark, you will pay the cost above the benchmark. Nationally, about 60% of the prescription drug plans will have premiums that are above the benchmarks.

Low-Income Benchmark Premium Levels, 2006

Region	State(s)	Extra Help Premium Subsidy
1	NH, ME	$36.09
2	CT, MA, RI, VT	$30.27
3	NY	$29.83
4	NJ	$31.37
5	DE, DC, MD	$33.46
6	PA, WV	$32.59
7	VA	$34.42
8	NC	$36.30
9	SC	$34.88
10	GA	$33.15
11	FL	$29.07
12	AL, TN	$32.33
13	MI	$33.22
14	OH	$30.69
15	IN, KY	$35.69
16	WI	$31.27
17	IL	$31.60
18	MO	$31.37
19	AR	$35.45
20	MS	$36.39
21	LA	$34.14
22	TX	$31.68
23	OK	$35.13
24	KS	$33.44
25	IA, MN, MT, ND,NE, SD, WY	$33.11
26	NM	$25.95
27	CO	$28.92
28	AZ	$24.62
29	NV	$23.46
30	OR, WA	$30.60
31	ID, UT	$33.62
32	CA	$23.25
33	HI	$27.44
34	AK	$34.66

CMS' Medicare & You 2006 handbook was mailed to all beneficiaries in October. It contains a significant error affecting dually eligible beneficiaries. The mistake is found in the printed area-specific versions of the handbooks, in the comparison charts listing the Medicare Prescription Drug Plans, beginning with page 97-A. The last column of the chart is headed "If I Qualify for Extra Help, Will My Full Premium be Covered?" For each plan listed, this column should show "Yes" if the plan's premium is at or below the regional benchmark, and a beneficiary who qualifies for the low-income subsidy (or is a dual eligible) would pay no premium for this plan. The column should say "No" if the plan's premium is above the regional benchmark and a beneficiary who qualifies for the low-income subsidy (or is a dual-eligible) would pay the cost above the benchmark. Due to the error, this column lists "Yes" for every plan. In fact, approximately 60% of the Prescription Drug Plans listed in the handbook should have a "No" in this column.

The corrected version is at http://www.medicare.gov/spotlights.asp#medicare2006

Medicare.gov's "Landscape of Local Plans" lists all plans with premiums at or below the average benchmark.

The PDP landscape of local plans download is also a useful download found on the CMS webpage at www.cms.hhs.gov/PrescriptionDrugCovGenIn. It includes a state by state listing of all the plans and indicates which standard plans are below the benchmark for that region.

When viewing the PDP document the plans with "dots" under the column "No Premium with Full Low Income Subsidy" are at or below the benchmark premium. Dual eligibles who enroll in these plans will not pay a premium. There may be some plans that are below the regional benchmark that do not have a dot. This is because they are enhanced plans. Medicare will only pay for the premiums for standard coverage that is below the regional benchmark. Enhanced plans usually have some feature that is better than the standard coverage described in the law which may or may not be advantageous for dual eligibles. You will need to check with the plan to find out what your additional premiums would be if you choose an enhanced plan. This site also includes information about the Medicare Advantage (MA) Cost Plans and Demonstrations in each region.

The Medicare Prescription Drug Plan Finder can be accessed at www.medicare.gov and click on "Compare Medicare Prescription Drug Plans." To do a "personalized" search you will need the dual eligible's Medicare card, the prescription drugs s/he takes, the dosage of each and the pharmacy that is most convenient to them. The Plan Finder is expected to be completed by November 15th and will include formulary information and cost sharing for each plan but it is best to confirm that information with the plan before enrolling.