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2012 PDP-Planner:
Medicare Part D Doughnut Hole Calculator
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
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.
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: $100.00 x 12 = $1,200.00
  • quarterly retail: $400.00 x 4 = $1,600.00
  • semi-annual retail: $1,200.00 x 2 = $2,400.00
  • annual retail: $875.00 x 1 = $875.00
  • total retail of $6,075.00 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): with start of new plan year
Your total annual Out-of-Pocket Costs without premium: $2,305.00

2012 Donut Hole Calculation Details

Month
Plan Phase		 Who Pays Total
Retail
You Plan Mfgr Gov
$$1: JanInitial Coverage $643.75 $1,931.25 $0.00 $0.00 $2,575.00
You are in the Initial Coverage Phase. Your costs so far $643.75.
$$2: FebInitial 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.
$$3: MarInitial Coverage $25.00 $75.00 $0.00 $0.00 $2,775.00
You are in the Initial Coverage Phase. Your costs so far $693.75.
$$4: AprInitial Coverage $38.75 $116.25 $0.00 $0.00 $2,930.00
You are in the Initial Coverage Phase. Your costs so far $732.50.
$$4: AprDonut Hole $172.50 $0.00 $172.50 $0.00 $3,275.00
You entered the Coverage Gap (Donut Hole) in April.
Your costs so far including the 2012 Coverage Gap Discount are $905.00. Your credit toward exiting the Coverage Gap is $1,077.50. This includes what you spent plus what the brand-name drug manufacturer (Mfgr) spent on your behalf. For plan year 2012, Non-LIS Medicare Beneficiaries get a 14% discount on generics and a 50% discount on brand-name drugs purchased in the Coverage Gap. Read Q&A about the Discount...
$$5: MayDonut Hole $50.00 $0.00 $50.00 $0.00 $3,375.00
You are still in the Donut Hole. Your costs so far including the 2012 Coverage Gap Discount are $955.00. Your credit toward exiting the Coverage Gap is $1,177.50.
$$6: JunDonut Hole $50.00 $0.00 $50.00 $0.00 $3,475.00
You are still in the Donut Hole. Your costs so far including the 2012 Coverage Gap Discount are $1,005.00. Your credit toward exiting the Coverage Gap is $1,277.50.
$$7: JulDonut Hole $850.00 $0.00 $850.00 $0.00 $5,175.00
You are still in the Donut Hole. Your costs so far including the 2012 Coverage Gap Discount are $1,855.00. Your credit toward exiting the Coverage Gap is $2,977.50.
$$8: AugDonut Hole $50.00 $0.00 $50.00 $0.00 $5,275.00
You are still in the Donut Hole. Your costs so far including the 2012 Coverage Gap Discount are $1,905.00. Your credit toward exiting the Coverage Gap is $3,077.50.
$$9: SepDonut Hole $50.00 $0.00 $50.00 $0.00 $5,375.00
You are still in the Donut Hole. Your costs so far including the 2012 Coverage Gap Discount are $1,955.00. Your credit toward exiting the Coverage Gap is $3,177.50.
$$10: OctDonut Hole $250.00 $0.00 $250.00 $0.00 $5,875.00
You are still in the Donut Hole. Your costs so far including the 2012 Coverage Gap Discount are $2,205.00. Your credit toward exiting the Coverage Gap is $3,677.50.
$$11: NovDonut Hole $50.00 $0.00 $50.00 $0.00 $5,975.00
You are still in the Donut Hole. Your costs so far including the 2012 Coverage Gap Discount are $2,255.00. Your credit toward exiting the Coverage Gap is $3,777.50.
$$12: DecDonut Hole $50.00 $0.00 $50.00 $0.00 $6,075.00
You are still in the Donut Hole. Your costs so far including the 2012 Coverage Gap Discount are $2,305.00. Your credit toward exiting the Coverage Gap is $3,877.50.

Summary		 Who Pays Total
Retail
You Plan Mfgr Gov
Totals without premium: $2,305.00 $2,197.50 $1,572.50 $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.
**For plan years 2011 to 2024, the chart values include the Donut Hole Discount. Read Q&A about the Discount.
***Beginning with plan year 2024, the Inflation Reduction Act (IRA) of 2022 eliminates beneficiary cost-sharing once your TrOOP reaches the established maximum cap on out-of-pocket spending for Part D formulary drugs (RxMOOP).
Legend:
$$$ You are responsible for 100% of your prescription (Rx) costs. This occurs during the Initial Deductible phase of coverage. (Many plans do not have an initial deductible or exclude low-cost generic drugs from the deductible. ) It also occurred in the Coverage Gap (Donut Hole) unless your plan has Donut Hole coverage.
$$ 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 copayment 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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