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Medicare Part D potential benefits
The charts below can help you determine your potential out-of-pocket costs for the new Medicare Part D coverage.
To determine your estimated costs use the column that reflects your annual household income. The appropriate column will show your expected annual Medicare Part D premium, your co-pay for medications, and your share of annual drug costs (based upon your annual individual drug costs).
Benefits for married individuals
Annual household income |
Less than $13,250 |
$13,250 - $17,887 |
$17,888 - $19,875 |
Greater than $19,875 |
| Estimated annual Medicare Part D Premium | Free | Free | $0 - $420 | $420 or higher |
| Co-pay | $1 generic $3 brand |
$2 generic $5 brand |
Based on deductible & co-insurance responsibilities | Based on deductible & co-insurance responsibilities |
| Annual individual drug cost | Your share of annual drug costs (excluding premium) | |||
| $50 | $1 | $1 | $40 | $40 |
| $100 | $3 | $6 | $54 | $80 |
| $200 | $4 | $7 | $66 | $160 |
| $400 | $9 | $15 | $90 | $267 |
| $800 | $19 | $34 | $138 | $347 |
| $1,200 | $28 | $49 | $186 | $427 |
| $1,600 | $37 | $64 | $234 | $507 |
| $2,400 | $56 | $98 | $330 | $667 |
| $3,200 | $75 | $132 | $426 | $1,060 |
| $4,000 | $93 | $162 | $522 | $1,700 |
| $4,800 | $112 | $196 | $618 | $2,340 |
| $5,500 | $128 | $224 | $702 | $2,900 |
| $11,000 | $256 | $448 | $1,362 | $3,789 |
| $22,000 | $513 | $897 | $2,682 | $4,240 |
To determine annual out-of-pocket drug costs, add your estimated annual Medicare Part D Premium and your share of annual drug costs.
Benefits for single individuals
Annual household income |
Less than $10,295 |
$10,295 - $13,896 |
$13,897 - $15,441 |
Greater than $15,441 |
| Estimated annual Medicare Part D Premium | Free | Free | $0 - $420 | $420 or higher |
| Co-pay | $1 generic $3 brand |
$2 generic $5 brand |
Based on deductible & co-insurance responsibilities | Based on deductible & co-insurance responsibilities |
| Annual individual drug cost | Your share of annual drug costs (excluding premium) | |||
| $50 | $1 | $1 | $40 | $40 |
| $100 | $3 | $6 | $54 | $80 |
| $200 | $4 | $7 | $66 | $160 |
| $400 | $9 | $15 | $90 | $267 |
| $800 | $19 | $34 | $138 | $347 |
| $1,200 | $28 | $49 | $186 | $427 |
| $1,600 | $37 | $64 | $234 | $507 |
| $2,400 | $56 | $98 | $330 | $667 |
| $3,200 | $75 | $132 | $426 | $1,060 |
| $4,000 | $93 | $162 | $522 | $1,700 |
| $4,800 | $112 | $196 | $618 | $2,340 |
| $5,500 | $128 | $224 | $702 | $2,900 |
| $11,000 | $256 | $448 | $1,362 | $3,789 |
| $22,000 | $513 | $897 | $2,682 | $4,240 |
To determine annual out-of-pocket drug costs, add your estimated annual Medicare Part D Premium and your share of annual drug costs.