2006 Donut Hole Calculation Summary: | |
Summary of the annual retail cost of your drugs:
|
|
Percentage of Generic vs. Brand drug purchases used: | |
No factor 100% Responsible in Gap | |
You will enter the Coverage Gap (Donut Hole): | in January |
You will exit the Coverage Gap (Donut Hole): | in July |
Your total annual Out-of-Pocket Costs without premium: | $4,062.50 |
2006 Donut Hole Calculation Details | |||||||
Month |
Plan Phase |
Who Pays | Total Retail |
||||
You | Plan | Mfgr | Gov | ||||
$$$ | 1: Jan | Deductible | $250.00 | $0.00 | $0.00 | $0.00 | $250.00 |
Your deductible is less than your Rx costs for the month, so here we will use the deductible of $250 and on the next line you will see your initial coverage costs for the remainder of this month. Your costs so far $250. | |||||||
$$ | 1: Jan | Initial Coverage | $500.00 | $1,500.00 | $0.00 | $0.00 | $2,250.00 |
You satisfied the remainder of your deductible ($250) earlier this month. Now, in the Initial Coverage phase, you pay 25% of the remaining Rx costs for the month ($2,000.00) (upto the initial coverage limit--ICL) and your plan pays 75%. Some plan offer copayments instead.* Your costs so far $750.00. | |||||||
$$$ | 1: Jan | Donut Hole | $150.00 | $0.00 | $0.00 | $0.00 | $2,400.00 |
You entered the Coverage Gap (Donut Hole) in January. Your costs so far $750.00. | |||||||
$$$ | 2: Feb | Donut Hole | $0.00 | $0.00 | $0.00 | $0.00 | $2,400.00 |
You are still in the Donut Hole. Your costs so far $750.00. | |||||||
$$$ | 3: Mar | Donut Hole | $0.00 | $0.00 | $0.00 | $0.00 | $2,400.00 |
You are still in the Donut Hole. Your costs so far $750.00. | |||||||
$$$ | 4: Apr | Donut Hole | $2,400.00 | $0.00 | $0.00 | $0.00 | $4,800.00 |
You are still in the Donut Hole. Your costs so far $750.00. | |||||||
$$$ | 5: May | Donut Hole | $0.00 | $0.00 | $0.00 | $0.00 | $4,800.00 |
You are still in the Donut Hole. Your costs so far $750.00. | |||||||
$$$ | 6: Jun | Donut Hole | $0.00 | $0.00 | $0.00 | $0.00 | $4,800.00 |
You are still in the Donut Hole. Your costs so far $750.00. | |||||||
$$$ | 7: Jul | Donut Hole | $550.00 | $0.00 | $0.00 | $0.00 | $5,350.00 |
You are still in the Donut Hole. Your costs so far $750.00. | |||||||
$ | 7: Jul | Catastrophic Coverage | $92.50 | $277.50 | $0.00 | $1,480.00 | $7,200.00 |
You exited the Coverage Gap (Donut Hole) in July and are now in the catastrophic coverage. We have used 5% to calculate your costs.
The actual calculation is $2.00 for generics, $5 for brands or 5% whichever is higher. Your costs so far $3,942.50. | |||||||
$ | 8: Aug | Catastrophic Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $7,200.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,942.50. | |||||||
$ | 9: Sep | Catastrophic Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $7,200.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,942.50. | |||||||
$ | 10: Oct | Catastrophic Coverage | $120.00 | $360.00 | $0.00 | $1,920.00 | $9,600.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $4,062.50. | |||||||
$ | 11: Nov | Catastrophic Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $9,600.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $4,062.50. | |||||||
$ | 12: Dec | Catastrophic Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $9,600.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $4,062.50. | |||||||
Summary |
Who Pays | Total Retail |
|||||
You | Plan | Mfgr | Gov | ||||
Totals without premium: | $4,062.50 | $2,137.50 | $0.00 | $3,400.00 | $9,600.00 | ||
Notes: *Copayments do not influence when you will enter and leave the Donut Hole (which is based on plan’s negotiated retail drug costs). It will only affect your out-of-pocket costs. | |||||||
Legend: | |||||||
$$$ | 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. ) | ||||||
$$ | You share your prescription (Rx) costs with your Medicare Part D plan provider. During the Initial Coverage Phase, you are responsible for 25% of your medication costs (basic or standard plans) or a copayment on enhanced plans. | ||||||
$ | You pay a small fraction of your prescription (Rx) costs. This occurs in Catastrophic Coverage. You pay 5% of your medication costs or $2.00 for generics or $5 for brand drugs (whichever is higher). |
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