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Understanding Your Explanation of Benefits
IRMAA: Higher premiums for higher incomes
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Donut Hole Calculator
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2021 Medicare Advantage Plans State Overview
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Pets are Family Too!
Use your drug discount card to save on medications for the entire family ‐ including your pets.
» Learn more about savings on Pet Medications
No enrollment fee and no limits on usage
Everyone in your household can use the same card, including your pets
Your drug discount card is available to you at
no cost
.
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Medicare Part D
Donut Hole Calculator
2021
PDP-Planner:
Medicare Part D Donut Hole Calculator
Try one of our examples or your own scenario ->
Example 1
illustrates how the Donut Hole (Coverage Gap) works when the beneficiary only has monthly prescription (Rx) costs.
Example 2
shows that if the same monthly costs are paid on a quarterly basis, the total retail costs do not change; however,
when
one enters and leaves the Coverage Gap does changes.
Example 3
shows an example of how to enter you medication costs if they are not consistent.
But isn’t the Coverage Gap (Donut Hole) closed?
Examples
Monthly Rx Costs only
Quarterly Rx Costs only
Combination of Rx Costs
Your Own Rx Cost Scenario
OR Enter your average prescription drug costs:
*
This is the actual retail cost of your covered prescriptions.
Do not include non-covered prescriptions or non-prescription medications (ex: aspirin or over-the-counter vitamins).
Paid Monthly:
Quarterly:
Semi-Annually:
Annually:
We will add all of these costs together to determine your total annual retail prescription costs. Since we do not know when you are making these non-regular purchases, we will place these payments starting in month one (1). You can find these values on your regular Medicare Part D plan statements or if you already know the annual costs, just enter the value in the annual costs field.
Percentage of Generic vs. Brand drug purchases:
*
CMS estimated standard 10.50% Generic / 89.50% Brand (vaccine adjusted)
10.50% Generic / 89.50% Brand (not vaccine adjusted)
0% Generic / 100% Brand (not vaccine adjusted)
25% Generic / 75% Brand (not vaccine adjusted)
50% Generic / 50% Brand (not vaccine adjusted)
75% Generic / 25% Brand (not vaccine adjusted)
100% Generic / 0% Brand (not vaccine adjusted)
No factor 100% Responsible in Gap
Because of the donut hole discount, the percentage of generic vs. brand drug purchases will determine if and when you will exit the Coverage Gap.
Enter your plan's deductible:
$
The 2021 standard deductible is $445.
Choose the your coverage start month - usually January:
*
January
February
March
April
May
June
July
August
September
October
November
December
Most plans start in January. If you are just turning 65 or a Medicaid recipient, your plan may start in a month other than January.
Enter your monthly premium:
$
You can enter your monthly premium, to have it calculated into the total.
*
required
Calculators Available:
PDP-Planner Calculators:
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2021
Plan Out-of-Pocket Cost Calculators:
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2010
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Sign-up for our Medicare Part D Newsletter.
PDP-Facts: 2021 Medicare Part D plan Facts & Figures
2021 PDP-Finder: Medicare Part D (Drug Only) Plan Finder
PDP-Compare: 2020/2021 Medicare Part D plan changes
2021 MA-Finder: Medicare Advantage Plan Finder
MA plan changes 2020 to 2021
Drug Finder: 2021 Medicare Part D drug search
Formulary Browser: View any 2021 Medicare plan formulary
2021 Browse Drugs By Letter
Doughnut Hole Calculator
Guide to 2020/2021 LIS Mailings from CMS, Social Security and Plans
Q1Medicare FAQs: Most Read and Newest Questions & Answers
Q1Medicare Blog: Latest Medicare News
2022 Medicare Part D Reminder Service