Comparison of Provisions in Leading Medicare Drug Benefit Bills
Source: AARP Bulletin Today | 2003-08-26 11:45:04
| HOUSE REPUBLICANS | SENATE DEMOCRATS | |
| Premium | Average $33 a month (may vary among plans) | $25 a month |
| Deductible | $250 a year | None |
| Copayments | Beneficiary pays: 20 percent of drug costs from $251 to $1,000 a year; 50 percent from $1,001 to $2,000 a year; and all costs from $2,001 until the out-of-pocket limit is met. | Beneficiary pays a copay per prescription of $10 for generics, $40 for "preferred brand" drugs or $60 for "nonpreferred brands." |
| Catastrophic coverage | Once out-of-pocket costs (excluding premiums) reach $3,700 a year, Medicare pays all further costs. | Once out-of-pocket costs (excluding premiums) reach $4,000 a year, Medicare pays all further costs. |
| Low-income subsidies | Beneficiaries with incomes under 150 percent of the federal poverty level pay no premiums and pay copays per prescription of $2 (generics) or $5 (brands). Those with incomes from 150 to 175 percent of the federal poverty level pay reduced premiums and $2 or $5 copays. | Beneficiaries with incomes up to 135 percent of the federal poverty level pay no premiums or copays. Those with incomes from 135 to 150 percent of the federal poverty level pay reduced premiums and standard copays per prescription of $10 (generics) and $40 or $60 for brand names. |
| How program would be run | Through private insurance plans. Actual benefits and costs vary between plans and areas. | Through private pharmacy benefit managers. Benefits and costs same for all enrollees. |
| Extent of coverage | No coverage after $2,000 drug costs until enrollee has spent $3,700 of own money. | No gap in coverage. |
| Duration | Starts 2005. Program has no time limit. | 2004-2011. Congress to reauthorize after 8 years. |
| Overall cost | Official estimate: $310 billion over 10 years. | Unofficial estimate: $425 billion over 8 years. |
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