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2025 PDP-Planner:
Medicare Part D Out-of-Pocket Cost Calculator
Try one of our examples or your own scenario ->
Example 1 illustrates out-of-pocket costs 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 enters Catastrophic Coverages changes.
Example 3 shows an example of how to enter you medication costs if they are not consistent.
Examples
  1. Monthly Rx Costs only
  2. Quarterly Rx Costs only
  3. Combination of Rx Costs
  4. 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 use these costs to determine your total annual retail prescription costs. You can find your retail drug costs on your regular Medicare Part D plan statements.
Percentage of Generic vs. Brand drug purchases:*
Because of the Manufacturer Discount Program, the ratio of generic vs. brand-name drugs purchased determines the percentage paid by your drug plan, drug manaufacturer and/or the government.
Enter your plan's deductible:
$
The 2025 standard deductible is $590.
Choose the your coverage start month - usually January:*
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

2025 PDP-Planner Out-of-Pocket Cost Calculation Summary:
Summary of the annual retail cost of your drugs:
  • monthly retail: $519.17 x 12 = $6,230.04
  • quarterly retail: $0.00 x 4 = $0.00
  • semi-annual retail: $0.00 x 2 = $0.00
  • annual retail: $0.00 x 1 = $0.00
  • total retail of $6,230.04 to be used over 12 months of coverage
Percentage of Generic vs. Brand drug purchases used:
7.41% Generic / 92.59% Brand (not vaccine adjusted)
Your total annual Out-of-Pocket Costs without premium: $2,000.00

2025 PDP-Planner Out-of-Pocket Cost Calculation Details

Month
Plan Phase		 Who Pays Total
Retail
You Plan Mfgr Gov
$$$1: JanDeductible $519.17 $0.00 $0.00 $0.00 $519.17
Your remaining deductible is higher than to your Rx costs for the month, so the remainder of your deductible ($70.83) will be carried over to the next month. Your costs so far: $519.17.
$$$2: FebDeductible $70.83 $0.00 $0.00 $0.00 $590.00
Your deductible is less than your Rx costs for the month, so here we will use the deductible of $70.83 and on the next line you will see your initial coverage costs for the remainder of this month. Your costs so far: $590.
$$2: FebInitial Coverage $112.09 $294.74 $41.51 $0.00 $1,038.34
You satisfied the remainder of your deductible ($70.83) earlier this month.
Now, you will stay in the Initial Coverage phase until your TrOOP reaches the RxMOOP of $2000.
You pay 25% of the Rx costs over your deductible ($448.34).
For your generic drug costs ($33.22), the remaining 75% is paid by your drug plan. For your brand-name drug costs ($415.12), the remaining 75% is shared -- 65% is paid by your plan and 10% paid by the drug manufacturer.
Some plan offer copayments instead.*
Your costs so far: $702.09.
$$3: MarInitial Coverage $129.79 $341.31 $48.07 $0.00 $1,557.51
You are still in the Initial Coverage phase, you pay 25% of your Rx costs ($519.17).
For your generic drug costs ($38.47), your drug plan pays 75%
For your brand-name drug costs ($480.70), your drug plan pays 65% and the drug manufacturer 10%**
Your costs so far: $831.88.
$$4: AprInitial Coverage $129.79 $341.31 $48.07 $0.00 $2,076.68
You are still in the Initial Coverage phase, you pay 25% of your Rx costs ($519.17).
For your generic drug costs ($38.47), your drug plan pays 75%
For your brand-name drug costs ($480.70), your drug plan pays 65% and the drug manufacturer 10%**
Your costs so far: $961.67.
$$5: MayInitial Coverage $129.79 $341.31 $48.07 $0.00 $2,595.85
You are still in the Initial Coverage phase, you pay 25% of your Rx costs ($519.17).
For your generic drug costs ($38.47), your drug plan pays 75%
For your brand-name drug costs ($480.70), your drug plan pays 65% and the drug manufacturer 10%**
Your costs so far: $1,091.46.
$$6: JunInitial Coverage $129.79 $341.31 $48.07 $0.00 $3,115.02
You are still in the Initial Coverage phase, you pay 25% of your Rx costs ($519.17).
For your generic drug costs ($38.47), your drug plan pays 75%
For your brand-name drug costs ($480.70), your drug plan pays 65% and the drug manufacturer 10%**
Your costs so far: $1,221.26.
$$7: JulInitial Coverage $129.79 $341.31 $48.07 $0.00 $3,634.19
You are still in the Initial Coverage phase, you pay 25% of your Rx costs ($519.17).
For your generic drug costs ($38.47), your drug plan pays 75%
For your brand-name drug costs ($480.70), your drug plan pays 65% and the drug manufacturer 10%**
Your costs so far: $1,351.05.
$$8: AugInitial Coverage $129.79 $341.31 $48.07 $0.00 $4,153.36
You are still in the Initial Coverage phase, you pay 25% of your Rx costs ($519.17).
For your generic drug costs ($38.47), your drug plan pays 75%
For your brand-name drug costs ($480.70), your drug plan pays 65% and the drug manufacturer 10%**
Your costs so far: $1,480.84.
$$9: SepInitial Coverage $129.79 $341.31 $48.07 $0.00 $4,672.53
You are still in the Initial Coverage phase, you pay 25% of your Rx costs ($519.17).
For your generic drug costs ($38.47), your drug plan pays 75%
For your brand-name drug costs ($480.70), your drug plan pays 65% and the drug manufacturer 10%**
Your costs so far: $1,610.63.
$$10: OctInitial Coverage $129.79 $341.31 $48.07 $0.00 $5,191.70
You are still in the Initial Coverage phase, you pay 25% of your Rx costs ($519.17).
For your generic drug costs ($38.47), your drug plan pays 75%
For your brand-name drug costs ($480.70), your drug plan pays 65% and the drug manufacturer 10%**
Your costs so far: $1,740.43.
$$11: NovInitial Coverage $129.79 $341.31 $48.07 $0.00 $5,710.87
You are still in the Initial Coverage phase, you pay 25% of your Rx costs ($519.17).
For your generic drug costs ($38.47), your drug plan pays 75%
For your brand-name drug costs ($480.70), your drug plan pays 65% and the drug manufacturer 10%**
Your costs so far: $1,870.22.
$$12: DecInitial Coverage $129.78 $341.28 $48.07 $0.00 $6,230.00
You are still in the Initial Coverage phase, you pay 25% of your Rx costs ($519.13).
For your generic drug costs ($38.47), your drug plan pays 75%
For your brand-name drug costs ($480.66), your drug plan pays 65% and the drug manufacturer 10%**
Your costs so far: $2,000.00.
$012: DecCatastrophic Coverage $0.00 $0.02 $0.01 $0.01 $6,230.04
Your TrOOP reached the RxMOOP of $2000 earlier this month.
Your remaining drug costs ($0.04) fall into the Catastrophic Coverage phase where you have 100% coverage ($0 copay) for your formulary medication purchases until the end of the year.
Your costs for the year: $2,000.00.

Summary		 Who Pays Total
Retail
You Plan Mfgr Gov
Totals without premium: $2,000.00 $3,707.82 $522.22 $0.01 $6,230.04
Notes:
*Copayments can influence when you enter the Catastrophic Coverage phase.
** The 10% paid by the brand-name drug manufacturer is NOT included in your TrOOP and does not count toward reaching RxMOOP.
*** The Coverage Gap (Donut Hole) is eliminated in 2025.
Legend:
$$$ You are responsible for 100% of your prescription (Rx) costs. This occurs during the Initial Deductible phase of coverage. (Many plans do not have an initial deductible or exclude low-cost generic drugs from the deductible. Covered insulin products and ACIP vaccines are excluded from the deductible.)
$$ You share your prescription (Rx) costs with your Medicare Part D plan provider and you receive a Manufacturer Discount on brand-name drug purchases. During the Initial Coverage Phase, you are responsible for 25% of your medication costs (basic or standard plans) or a copayment on enhanced plans.
$0 You pay $0 for your medications -- you have 100% coverage for your formulary prescription (Rx) purchases. This occurs in the Catastrophic Coverage phase.



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This Q1Medicare.com Out-of-Pocket Cost calculator is based on the 2025 CMS Standard Benefit Medicare Part D plan and designed to estimate a Medicare Part D beneficiary's (1) potential prescription costs for the year and when they move through the various phases of coverage. The actual costs and timing may vary depending on the chosen Medicare Part D plan.


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  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
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  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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