Out-of-Pocket Drug Spending for Standard Plan

The cost estimates on the chart indicating the 2009 standard plan according to Medicare. Individual plans may vary and may not include all features described below. As the total amount you spend on prescription drugs grows throughout the year, you will proceed through some or all of the four steps of coverage, in addition to paying your selected drug plan's premium. To count toward your out-of-pocket expenses, drugs must be on your selected plan's formulary list.

Step 1

You pay: Your deductible, $295.
Plan pays: $0.
Receive: Drugs worth $295.

Step 2

You pay: Co-insurance of 25 percent or $601.
Plan pays: Up to $1,803.
Receive: Drugs worth $2,000.

Step 3

You pay: All costs up to $3,453. 
Plan pays: $0.
Receive: Drugs worth $3,453. Out-of-Pocket Threshold is $4,350 for the individual.

Step 4 (over $6,153.25)

You pay: Whatever is greater, 5 percent of cost of prescription or $2.40 generic or $6 brand name drug.
Plan pays:15 percent and Medicare 80 percent.
Receive: Drugs worth unlimited value to end of calendar year.

*Information compiled by the Baltimore County Department of Aging

© Copyright 2009 Baltimore County Department of Aging