Universal … Progressive … Affordable

• Zero Premium: This benefit would be incorporated into the existing Medicare Part B program. No separate premium and no increase in Part B premium.
• Universal Eligibility: All Part B enrollees.
• Universal Protection Against High Drug Costs: Medicare will pay 80 percent of the cost of drugs after beneficiary has total drug costs of $4,000. The individual will pay based on a flat three-tiered co-payment: $4/$16/$24*
• Benefit Counts All Drug Spending: Negotiated drug costs B not just the beneficiaries= out-of-pocket spending B counts toward the $4,000 deductible.
• Low-Income Benefits: Beneficiaries up to 200 percent of federal poverty rate will be eligible to receive enhanced benefits via Medicare drug discount cards, Medicare+Choice, Medicaid, Medigap, and other new coverage options.

State option with a federal/state match at the SCHIP rate)

• Universal Benefit Via Medicare Approved Drug Card Plans: A wide variety of Medicare approved drug card plans including PBMs, State Assistance Plans, retiree coverage, Medigap, Medicare + Choice, Medicaid and others that offer all seniors access to the market-based discounts widely available to people with private insurance. These discounts would apply to all drug purchases.
• Universal Benefit Via Current Coverage: Encourage the continuation of current drug coverage through Employer/Retiree plans, Medigap plans, Medicaid, State pharmaceutical assistance plans, or Medicare+Choice plans; all based on reimbursement agreements with Medicare.
• CBO Cost Estimate: Under $400 billion
• More to Come: This proposal is just a first step in getting a Medicare prescription drug benefit up and running quickly – leaving room for expansion in the future.

* The tiered co-payment estimate is based on the actuarial equivalent of an 80/20 cost-share.

** The tiered co-payment estimate is based on the actuarial equivalent of a 70/30 cost-share.

*** The tiered co-payment estimate is based on the actuarial equivalent of a 50/50 cost-share.