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Note:  The amounts in this table do not apply to beneficiaries who have the Part D Low Income Subsidy (“Extra Help”)

Annual Deductible Maximum


Initial Coverage Period

Cost sharing during this period may be a flat 25% co-insurance OR the plan may have a tiered system of co-pays and co-insurance that is actuarially equivalent to 25%

Initial Coverage Limit

(Once the member AND the plan have spent this amount, the member enters the Donut Hole)


Donut Hole

 During this period the member pays reduced costs for both generic and brand name drugs.  On brand name drugs the member receives a 50% manufacturer discount and a further 10% subsidy from Medicare.  On generic drugs the member receives a 49% subsidy from Medicare.  The full cost of brand name drugs, minus the subsidy, counts toward TROOP (90%); the price paid for generic drugs (51%) counts also counts toward TROOP.

Catastrophic Coverage Threshold

Catastrophic coverage begins when the member’s true out-of-pocket (TROOP) costs equals this amount.


Total member spending before Catastrophic Coverage


Cost sharing during Catastrophic Coverage

$3.30 (generics) / $8.25 (brand name)

OR 5%, whichever is greater

2.         2017 Low Income Subsidy (LIS) Co-Pay Amounts


Generics Co-pay

Brand Name Co-Pay


Institutionalized FBDE or on HCBS waiver program




FBDE at or below 100% FPL




FBDE over 100% FPL




Full Subsidy (up to 135% FPL)




Partial Subsidy (up to 150% FPL)




3.         2017 Total Donut Hole Discounts:   60% – brand name (50% + 10%); 49% – generic

4.         2017 Average Monthly Premium:  $34.00

5.         2017 LIS Benchmark Threshold in Connecticut: $34.83

6.         2017 National Base Beneficiary Premium: $35.63 (used to calculate Part D Late Enrollment Penalty and income-related monthly adjustment amounts [IRMAA])

7.         2017 IRMAA threshold amounts:  $85,000 single, $170,000 couples

8.         2017 Medicare Advantage MOOPs: in-network, 6,700; in and out-of- network combined – $10,000

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