2012 Donut Hole Calculation Summary: | |
Summary of the annual retail cost of your drugs:
|
|
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 | ||||
$$ | 1: Jan | Initial Coverage | $600.00 | $1,800.00 | $0.00 | $0.00 | $2,400.00 |
You are in the Initial Coverage Phase. Your costs so far $600.00. | |||||||
$$ | 2: Feb | Initial 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. | |||||||
$$ | 3: Mar | Initial Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $2,400.00 |
You are in the Initial Coverage Phase. Your costs so far $600.00. | |||||||
$$ | 4: Apr | Initial 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. | |||||||
$$ | 4: Apr | Donut Hole | $935.00 | $0.00 | $935.00 | $0.00 | $4,800.00 |
You entered the Coverage Gap (Donut Hole) in April. Your costs so far including the 2012 Coverage Gap Discount are $1,667.50. Your credit toward exiting the Coverage Gap is $2,602.50. This includes what you spent plus what the brand-name drug manufacturer (Mfgr) spent on your behalf. For plan year 2012, Non-LIS Medicare Beneficiaries get a 14% discount on generics and a 50% discount on brand-name drugs purchased in the Coverage Gap. Read Q&A about the Discount... | |||||||
$$ | 5: 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 including the 2012 Coverage Gap Discount are $1,667.50. Your credit toward exiting the Coverage Gap is $2,602.50. | |||||||
$$ | 6: Jun | Donut Hole | $0.00 | $0.00 | $0.00 | $0.00 | $4,800.00 |
You are still in the Donut Hole. Your costs so far including the 2012 Coverage Gap Discount are $1,667.50. Your credit toward exiting the Coverage Gap is $2,602.50. | |||||||
$$ | 7: Jul | Donut 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: Jul | Catastrophic 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: 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 $2,731.38. | |||||||
$ | 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 $2,731.38. | |||||||
$ | 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 $2,851.38. | |||||||
$ | 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 $2,851.38. | |||||||
$ | 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 $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... |
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$ | 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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