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State of Hawaii
Department of Health
Executive Office on Aging

No. 1 Capitol District
250 South Hotel Street,
Rm 406
Honolulu, Hawaii
96813-2831

Phone: (808) 586-0100
Fax (808) 586-0185
eoa@doh.hawaii.gov

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Part D – Medicare Prescription Drug Program, January 2007 Costs to Beneficiary (without limited-income subsidy)
  • About a $30 monthly premium


  • $265 deductible (each year)


  • 25% of drug costs from $266 to $2,400
        Medicare pays 75%, (so beneficiary pays about $534)


  • 100% of drug costs from $2,400 to $5,451.25
        (so beneficiary pays about $3,051.25 out of pocket)
    This is the famous “donut hole” or coverage gap


  • After $3,850.25 ($265+$534+$3,051.25) in beneficiary out of
        pocket costs, Medicare pays 95% / beneficiary pays 5%

Limited-Income Assistance (Subsidy) "Extra Help" Under Part D

Full benefit dual eligibles
  • Full benefit dual eligibles are individuals who are entitled to Medicare Part A and/or Part B and are also eligible for outpatient prescription drug benefits through Medicaid.

    • Groups eligible for low-income subsidies
    Three groups have been identified for lower-income assistance (subsidies):

    Group 1
  • Full benefit dual eligibles with incomes below 100 percent of the Federal poverty level (FPL)


    • Group 2
  • Full benefit dual eligibles and non-dual eligible Medicare beneficiaries with incomes between 100 percent and 135 percent of the FPL, with resource limits of $7,500 per individual and $12,000 for a married couple


    • Group 3
  • Medicare beneficiaries with incomes between 135 percent and 150 percent of the FPL, with resource limits of $11,500 for an individual and $23,000 for a married couple


    • 2006 Hawaii Federal Poverty Levels (FPLs) - changes each year in February, see http://www.aspe.hhs.gov/poverty/

    IndividualsCouples
    100 % FPL = $11,270. / $940 month100% FPL = $15,180 / $1,265 month
    135% FPL = $15,214 / $1,267 month135% FPL = $20,493 / $1,707 month
    150% FPL = $16,905. / $1,408 month150% FPL = $22,770 / $1,897 month

    Assistance (subsidy) for each group

    Group 1
           No monthly premium or the deductible under basic plan
           Co-payments - $1 for generics and $3.10 for brand-name drugs (Hawaii Smooth Transitions)
    If through paying these nominal co-pays the beneficiary reaches $3,850 in out-of-pocket costs, they are not responsible for any other co-pays for the rest of the year
    Note: Those full benefit dual eligibles in nursing homes will have no cost sharing

    Group 2
           No monthly premium or the deductible under basic plan
           Co-payments - $2.15 for generic drugs and $5.35 for brand-name drugs
    If through paying these nominal co-pays the beneficiary reached $3,850 in out-of-pocket costs, they are not responsible for any other co-pays for the rest of the year

    Group 3
           Monthly premium based on a sliding scale depending upon income under basic plan
           Reduced deductible of $53 per year
    Responsible for 15 percent of the cost of prescriptions up to the $3,850 out-of-pocket maximum Once maximum reached, co-payments - $2.15 for generic drugs and $5.35 for brand-name drugs for the rest of the year