2009 Donut Hole Calculation Summary: | |
Summary of the annual retail cost of your drugs:
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Percentage of Generic vs. Brand drug purchases used: | |
No factor 100% Responsible in Gap | |
You will enter the Coverage Gap (Donut Hole): | in March |
You will exit the Coverage Gap (Donut Hole): | with start of new plan year |
Your total annual Out-of-Pocket Costs without premium: | $4,050.00 |
2009 Donut Hole Calculation Details | |||||||
Month |
Plan Phase |
Who Pays | Total Retail |
||||
You | Plan | Mfgr | Gov | ||||
$$ | 1: Jan | Initial Coverage | $643.75 | $1,931.25 | $0.00 | $0.00 | $2,575.00 |
You are in the Initial Coverage Phase. Your costs so far $643.75. | |||||||
$$ | 2: Feb | Initial Coverage | $25.00 | $75.00 | $0.00 | $0.00 | $2,675.00 |
You are in the Initial Coverage Phase. Your costs so far $668.75. | |||||||
$$ | 3: Mar | Initial Coverage | $6.25 | $18.75 | $0.00 | $0.00 | $2,700.00 |
You are in the Initial Coverage Phase. Your costs so far $675.00. | |||||||
$$$ | 3: Mar | Donut Hole | $75.00 | $0.00 | $0.00 | $0.00 | $2,775.00 |
You entered the Coverage Gap (Donut Hole) in March. Your costs so far $675.00. | |||||||
$$$ | 4: Apr | Donut Hole | $500.00 | $0.00 | $0.00 | $0.00 | $3,275.00 |
You are still in the Donut Hole. Your costs so far $675.00. | |||||||
$$$ | 5: May | Donut Hole | $100.00 | $0.00 | $0.00 | $0.00 | $3,375.00 |
You are still in the Donut Hole. Your costs so far $675.00. | |||||||
$$$ | 6: Jun | Donut Hole | $100.00 | $0.00 | $0.00 | $0.00 | $3,475.00 |
You are still in the Donut Hole. Your costs so far $675.00. | |||||||
$$$ | 7: Jul | Donut Hole | $1,700.00 | $0.00 | $0.00 | $0.00 | $5,175.00 |
You are still in the Donut Hole. Your costs so far $675.00. | |||||||
$$$ | 8: Aug | Donut Hole | $100.00 | $0.00 | $0.00 | $0.00 | $5,275.00 |
You are still in the Donut Hole. Your costs so far $675.00. | |||||||
$$$ | 9: Sep | Donut Hole | $100.00 | $0.00 | $0.00 | $0.00 | $5,375.00 |
You are still in the Donut Hole. Your costs so far $675.00. | |||||||
$$$ | 10: Oct | Donut Hole | $500.00 | $0.00 | $0.00 | $0.00 | $5,875.00 |
You are still in the Donut Hole. Your costs so far $675.00. | |||||||
$$$ | 11: Nov | Donut Hole | $100.00 | $0.00 | $0.00 | $0.00 | $5,975.00 |
You are still in the Donut Hole. Your costs so far $675.00. | |||||||
$$$ | 12: Dec | Donut Hole | $100.00 | $0.00 | $0.00 | $0.00 | $6,075.00 |
You are still in the Donut Hole. Your costs so far $675.00. | |||||||
Summary |
Who Pays | Total Retail |
|||||
You | Plan | Mfgr | Gov | ||||
Totals without premium: | $4,050.00 | $2,025.00 | $0.00 | $0.00 | $6,075.00 | ||
Notes: *Copayments do not influence when you will enter and leave the Donut Hole (which is based on plan’s negotiated retail drug costs). It will only affect your out-of-pocket costs. | |||||||
Legend: | |||||||
$$$ | 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 $2.40 for generics or $6 for brand drugs (whichever is higher). |
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