2007 PDP-Planner:
Medicare Part D Doughnut 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.

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.

Enter your plan's deductible:

$

The 2007 standard deductible is $265.

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

2007 Donut Hole Calculation Summary:
Summary of the annual retail cost of your drugs: monthly retail: $800.00 x 12 = $9,600.00 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 $9,600.00 to be used over 12 months of coverage
Percentage of Generic vs. Brand drug purchases used:
No factor 100% Responsible in Gap
You will enter the Coverage Gap (Donut Hole):	in April
You will exit the Coverage Gap (Donut Hole):	in July
Your total annual Out-of-Pocket Costs without premium:	$4,057.44

2007 Donut Hole Calculation Details
	Month	Plan Phase	Who Pays				Total Retail
			You	Plan	Mfgr	Gov
$$$	1: Jan	Deductible	$265.00	$0.00	$0.00	$0.00	$265.00
Your deductible is less than your Rx costs for the month, so here we will use the deductible of $265 and on the next line you will see your initial coverage costs for the remainder of this month. Your costs so far $265.
$$	1: Jan	Initial Coverage	$133.75	$401.25	$0.00	$0.00	$800.00
You satisfied the remainder of your deductible ($265) earlier this month. Now, in the Initial Coverage phase, you pay 25% of the remaining Rx costs for the month ($535.00) (upto the initial coverage limit--ICL) and your plan pays 75%. Some plan offer copayments instead.* Your costs so far $398.75.
$$	2: Feb	Initial Coverage	$200.00	$600.00	$0.00	$0.00	$1,600.00
You are in the Initial Coverage Phase. Your costs so far $598.75.
$$	3: Mar	Initial Coverage	$200.00	$600.00	$0.00	$0.00	$2,400.00
You are in the Initial Coverage Phase. Your costs so far $798.75.
$$$	4: Apr	Donut Hole	$800.00	$0.00	$0.00	$0.00	$3,200.00
You entered the Coverage Gap (Donut Hole) in April. Your costs so far $798.75.
$$$	5: May	Donut Hole	$800.00	$0.00	$0.00	$0.00	$4,000.00
You are still in the Donut Hole. Your costs so far $798.75.
$$$	6: Jun	Donut Hole	$800.00	$0.00	$0.00	$0.00	$4,800.00
You are still in the Donut Hole. Your costs so far $798.75.
$$$	7: Jul	Donut Hole	$651.25	$0.00	$0.00	$0.00	$5,451.25
You are still in the Donut Hole. Your costs so far $798.75.
$	7: Jul	Catastrophic Coverage	$7.44	$22.31	$0.00	$119.00	$5,600.00
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 $2.15 for generics, $5.35 for brands or 5% whichever is higher. Your costs so far $3,857.44.
$	8: Aug	Catastrophic Coverage	$40.00	$120.00	$0.00	$640.00	$6,400.00
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,897.44.
$	9: Sep	Catastrophic Coverage	$40.00	$120.00	$0.00	$640.00	$7,200.00
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,937.44.
$	10: Oct	Catastrophic Coverage	$40.00	$120.00	$0.00	$640.00	$8,000.00
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,977.44.
$	11: Nov	Catastrophic Coverage	$40.00	$120.00	$0.00	$640.00	$8,800.00
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $4,017.44.
$	12: Dec	Catastrophic Coverage	$40.00	$120.00	$0.00	$640.00	$9,600.00
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $4,057.44.
Summary			Who Pays				Total Retail
			You	Plan	Mfgr	Gov
Totals without premium:			$4,057.44	$2,223.56	$0.00	$3,319.00	$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 $2.15 for generics or $5.35 for brand drugs (whichever is higher).

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