We do have an online Cost calculator and Donut Hole estimator to Help
We provide different tools to help you estimate your Medicare Part D prescription drug spending: Our online Cost Calculator and our Donut Hole Calculator.
But remember:Retail drug costs can change throughout the plan year - as do your prescription needs - and the introduction of new generics or brand-name medications. In short, you cannot predict your Medicare plan spending with 100 percent accuracy, but you can calculate an estimate of your spending that will help you with budgeting for next year.
You can click on the links to calculate an estimate of your out-of-pocket expenditures with Medicare Part D prescription drug coverage.
Here is an example of how the out-of-pocket costs add-up.
If a Medicare beneficiary had prescription drug costs of $7508.75
per year, here is how much it would cost the Medicare Part D beneficiary personally or out-of-pocket:
|Annual Deductible (or first $405 spent):||-||$405 |
|25% of ($3750 - $405 = $3345):||-||$836.25|
|100% of ($7508.75 - $3750 = $3758.75):||-||$3758.75|
|Total Cost to Medicare Beneficiary (out-of-pocket):||-||$5000|
Therefore, our Medicare beneficiary that had Prescription drug costs of $7508.75
, would have approximately $5000
of out of pocket or personal costs per year.
What if our example Medicare beneficiary has Prescription drug costs of more than $7508.75?
Once our example Medicare Beneficiary has spent approximately $5000, the last paragraph of the guidelines goes into effect:
More than $5000 annual out-of-pocket threshold
- The Medicare Beneficiary pays: the greater of either: (1) 5% of the Prescription Drug Costs or (2) $3.35 for generic Prescription Drugs / $8.35 for brand-name Prescription Drugs.
- Medicare Pays: the lesser of either: (1) 95% of the Prescription Drug costs or (2) the balance of the Prescription Drug costs.
At this point in our example, the costs to the Medicare beneficiary will depend on the type/cost of prescription medication that is purchased. For example, if the Medicare beneficiary purchases non-generic Prescription drugs costing more than $8.35, the Medicare Beneficiary would need to pay 5% of the total costs.
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