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2012 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 add all of these costs together to determine your total annual retail prescription costs. Since we do not know when you are making these non-regular purchases, we will place these payments starting in month one (1). You can find these values on your regular Medicare Part D plan statements or if you already know the annual costs, just enter the value in the annual costs field.
Percentage of Generic vs. Brand drug purchases:*
Because of the donut hole discount, the percentage of generic vs. brand drug purchases will determine if and when you will exit the Coverage Gap.
Enter your plan's deductible:
$
The 2012 standard deductible is $320.
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

2012 Donut Hole Calculation Summary:
Summary of the annual retail cost of your drugs:
  • monthly retail: $0.00 x 12 = $0.00
  • quarterly retail: $2,400.00 x 4 = $9,600.00
  • 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:
0% Generic / 100% Brand (not vaccine adjusted)
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: $2,851.38

2012 Donut Hole Calculation Details

Month
Plan Phase		 Who Pays Total
Retail
You Plan Mfgr Gov
$$1: JanInitial Coverage $600.00 $1,800.00 $0.00 $0.00 $2,400.00
You are in the Initial Coverage Phase. Your costs so far $600.00.
$$2: FebInitial Coverage $0.00 $0.00 $0.00 $0.00 $2,400.00
You are in the Initial Coverage Phase. Your costs so far $600.00.
$$3: MarInitial Coverage $0.00 $0.00 $0.00 $0.00 $2,400.00
You are in the Initial Coverage Phase. Your costs so far $600.00.
$$4: AprInitial Coverage $132.50 $397.50 $0.00 $0.00 $2,930.00
You are in the Initial Coverage Phase. Your costs so far $732.50.
$$4: AprDonut Hole $935.00 $0.00 $935.00 $0.00 $4,800.00
You entered the Coverage Gap (Donut Hole) in April.
Your costs so far including the 2012 Coverage Gap Discount are $1,667.50. Your credit toward exiting the Coverage Gap is $2,602.50. This includes what you spent plus what the brand-name drug manufacturer (Mfgr) spent on your behalf. For plan year 2012, Non-LIS Medicare Beneficiaries get a 14% discount on generics and a 50% discount on brand-name drugs purchased in the Coverage Gap. Read Q&A about the Discount...
$$5: MayDonut Hole $0.00 $0.00 $0.00 $0.00 $4,800.00
You are still in the Donut Hole. Your costs so far including the 2012 Coverage Gap Discount are $1,667.50. Your credit toward exiting the Coverage Gap is $2,602.50.
$$6: JunDonut Hole $0.00 $0.00 $0.00 $0.00 $4,800.00
You are still in the Donut Hole. Your costs so far including the 2012 Coverage Gap Discount are $1,667.50. Your credit toward exiting the Coverage Gap is $2,602.50.
$$7: JulDonut Hole $1,048.75 $0.00 $1,048.75 $0.00 $6,897.50
You are still in the Donut Hole. Your costs so far including the 2012 Coverage Gap Discount are $2,716.25. Your credit toward exiting the Coverage Gap is $4,700.00.
$7: JulCatastrophic Coverage $15.13 $45.38 $0.00 $242.00 $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 $2.60 for generics, $6.5 for brands or 5% whichever is higher.
Your costs so far $2,731.38.
$8: AugCatastrophic 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 $2,731.38.
$9: SepCatastrophic 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 $2,731.38.
$10: OctCatastrophic 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 $2,851.38.
$11: NovCatastrophic 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 $2,851.38.
$12: DecCatastrophic 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 $2,851.38.

Summary		 Who Pays Total
Retail
You Plan Mfgr Gov
Totals without premium: $2,851.38 $2,602.88 $1,983.75 $2,162.00 $9,600.00
Notes:
* Co-payments 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.
** For plan years 2011 and on, the chart values include the Donut Hole Discount. Read Q&A about the Discount...
Legend:
$$$ You are responsible for 100% of your prescription (Rx) costs. This occurs during the Initial Deductible Phase of coverage. (Many plans do not have an initial deductible.) It also occurred in the Coverage Gap (Donut Hole) unless your plan has Donut Hole coverage.
$$ 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 co-payment on enhanced plans.

In plan year 2012, your drug costs are also shared during the Coverage Gap. The plan pays 14% of your generic drug costs and the drug manufacturer pays 50% of your brand drug costs. Read Q&A about the Discount...
$ You pay a small fraction of your prescription (Rx) costs. This occurs in Catastrophic Coverage. You pay 5% of your medication costs or $2.60 for generics or $6.5 for brand drugs (whichever is higher).



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This Q1Medicare.com Doughnut Hole calculator is based on the 2012 CMS Standard Benefit Medicare Part D plan and designed to estimate when a Medicare Part D beneficiary would (1) enter and exit the coverage gap and (2) the potential prescription costs for the year. The actual time when a Medicare Part D beneficiary enters the Doughnut Hole and the costs associated with the plan may vary depending on the chosen Medicare Part D plan.

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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
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  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
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  • 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.
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  • 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.
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  • 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.
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  • 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.
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  • 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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