$275

1. Plan Pays Beneficiary Pays Medicare Modernization Act Standard Benefit and Low-Income Subsidy Provisions All numbers are for 2008. Standard Drug Benefit Beneficiaries’ incomes >150% FPL and/or value of assets exceeds asset limit $25 / month estimated premium $275 $2510 $5726.25 $ + 75 % About 95% Beneficiaries’ incomes <150% FPL who also meet the asset test ($11,990 individual / $23,970 couple)* Sliding scale premium from $0 to the estimated $25 / month $5726.25 $56 $ + $2.25 - $5.60 co-pays apply 85 % Beneficiaries’ incomes <135% FPL who also meet the asset test ($7,790 individual / $12,440 couple)* and Full benefit dual eligibles for Medicaid who are beneficiaries >100% FPL, SSI beneficiaries without Medicaid, and Medicare Savings Program eligibles $0 premium $5726.25 $ + $2.25 - $5.60** co-pays apply 100 % Full Dual Eligibles for Medicaid with incomes 100% FPL $0 premium $5726.25 $ + $1.05 - $3.10** co-pays apply 100 % *Amounts include $1,500 per person for burial expenses **Cost sharing is $0 if the beneficiary is on Medicaid and institutionalized