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ALJ/MAC Decision Database



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Cost-Sharing for Part A and Part B


On October 1, 2007 the Centers for Medicare & Medicaid Services (CMS) announced Part A and Part B premiums and deductibles for 2008.[1] 


Hospital Deductible: $1,024 / benefit period


Hospital Coinsurance:

    Days 0-60: $0

    Days 61-90: $256 / day

    Days 91-150: $512 / day


Skilled Nursing Facility Coinsurance

    Days 0-20: $0

    Days 21-100: $128 / day


Part A Premium (for voluntary enrollees only)

    With 30-39 quarters of Social Security coverage: $233 / month

    With 29 or fewer quarters of Social Security coverage: $423 / month


Part B

    Deductible: $135 / year

    Standard Premium: $96.40 / month


Part B Income-Related Premium


Beneficiaries who file an individual tax return with income:

Beneficiaries who file a joint tax return with income:

Income-related monthly adjustment amount

Total monthly premium amount

Less than or equal to $82,000

Less than or equal to $164,000



Greater than $82,000 and less than or equal to $102,000

Greater than $164,000 and less than or equal to $204,000



Greater than $102,000 and less than or equal to $153,000

Greater than $204,000 and less than or equal to $306,000



Greater than $153,000 and less than or equal to $205,000

Greater than $306,000 and less than or equal to $410,000



Greater than $205000

Greater than $410,000




In addition, the monthly premium rates to be paid by beneficiaries who are married, but file a separate return from their spouse and lived with their spouse at some time during the taxable year are:


Beneficiaries who are married but file a separate tax return from their spouse:

Income-related monthly adjustment amount

Total monthly premium amount

Less than or equal to $82,000



Greater than $82,000 and less than or equal to $123,000



Greater than $123,000




Medicare Advantage Eligibility


    Must be enrolled in Medicare Parts A & B; enrollees are still in the Medicare program,

    Must continue to pay the Part B premium ($96.40 / month in 2008),

    Must live in the plan’s service area,

    Must not have end-stage renal disease (ESRD) at time of enrollment.


Standard Part D Cost-Sharing for 2008

On April 2, 2007 CMS issued information about Part D cost-sharing for 2008:[2]


Base Beneficiary Premium                                                        $27.93

Deductible                                                                                   $275.00

Initial Coverage Limit                                                                $2,510.00

Out-of-pocket Threshold                                                            $4,050.00

Total Covered Part D Drugs to Get to Catastrophic Limit      $5,726.25

Catastrophic cost-sharing:  Generic/ Preferred Drug               $2.25

                                       Other                                                     $5.60


Low-Income Subsidy Co-Payments (LIS)

Full Benefit Dual Eligibles w/incomes

             ≤ 100% Federal Poverty Level                

                        Generic/Preferred Drugs                                         $1.05

                        Other                                                                     $3.10

                        Above Catastrophic Limit                                       $0.00


Full Benefit Duals with Incomes

             >100% Federal Poverty Level &

             Other Full-Subsidy Eligible Beneficiaries

                        Generic/preferred drugs                                          $2.25

                        Other                                                                     $5.60

                        Above Catastrophic Limit                                       $0.00


Partial Subsidy Eligible Beneficiaries

            Deductible                                                                          $56.00

            Co-insurance to ICL                                                           15%

            Generics above catastrophic limit                                         $2.25

            Others above catastrophic limit                                            $5.60


CMS has also announced the elimination of the 2008 late enrollment penalty for any beneficiary who qualifies for the low-income subsidy and who enrolls in a drug plan through December 31, 2008.


Qualified Individual (QI) Program Extended


The President has signed legislation that will continue the Qualified Individual (QI) program through the end of 2007.  The President is expected to sign the legislation. This will assure the continued payment of Part B premiums for the approximately 1.5 million people who receive QI benefits.  The Center for Medicare Advocacy is working with many other organizations for the passage of legislation, before the end of the year, which would make the QI program permanent, rather than subject to periodic sunset provisions.  The QI benefit is doubly valuable to those who are eligible, as it pays the Part B premium (currently $93.50/month) and also entitles the beneficiary to the full Part D low income subsidy.



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