2016 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 May |
You will exit the Coverage Gap (Donut Hole): | with start of new plan year |
Your total annual Out-of-Pocket Costs without premium: | $2,071.75 |
2016 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. | |||||||
$$ | 3: Mar | Initial Coverage | $25.00 | $75.00 | $0.00 | $0.00 | $2,775.00 |
You are in the Initial Coverage Phase. Your costs so far $693.75. | |||||||
$$ | 4: Apr | Initial Coverage | $125.00 | $375.00 | $0.00 | $0.00 | $3,275.00 |
You are in the Initial Coverage Phase. Your costs so far $818.75. | |||||||
$$ | 5: May | Initial Coverage | $8.75 | $26.25 | $0.00 | $0.00 | $3,310.00 |
You are in the Initial Coverage Phase. Your costs so far $827.50. | |||||||
$$ | 5: May | Donut Hole | $29.25 | $3.25 | $32.50 | $0.00 | $3,375.00 |
You entered the Coverage Gap (Donut Hole) in May. Your costs so far including the 2016 Coverage Gap Discount are $856.75. Your credit toward exiting the Coverage Gap is $889.25. This includes what you spent plus what the brand-name drug manufacturer (Mfgr) spent on your behalf. For plan year 2016, Non-LIS Medicare Beneficiaries get a 42% discount on generics and a 55% discount on brand-name drugs purchased in the Coverage Gap. Read Q&A about the Discount... | |||||||
$$ | 6: Jun | Donut Hole | $45.00 | $5.00 | $50.00 | $0.00 | $3,475.00 |
You are still in the Donut Hole. Your costs so far including the 2016 Coverage Gap Discount are $901.75. Your credit toward exiting the Coverage Gap is $984.25. | |||||||
$$ | 7: Jul | Donut Hole | $765.00 | $85.00 | $850.00 | $0.00 | $5,175.00 |
You are still in the Donut Hole. Your costs so far including the 2016 Coverage Gap Discount are $1,666.75. Your credit toward exiting the Coverage Gap is $2,599.25. | |||||||
$$ | 8: Aug | Donut Hole | $45.00 | $5.00 | $50.00 | $0.00 | $5,275.00 |
You are still in the Donut Hole. Your costs so far including the 2016 Coverage Gap Discount are $1,711.75. Your credit toward exiting the Coverage Gap is $2,694.25. | |||||||
$$ | 9: Sep | Donut Hole | $45.00 | $5.00 | $50.00 | $0.00 | $5,375.00 |
You are still in the Donut Hole. Your costs so far including the 2016 Coverage Gap Discount are $1,756.75. Your credit toward exiting the Coverage Gap is $2,789.25. | |||||||
$$ | 10: Oct | Donut Hole | $225.00 | $25.00 | $250.00 | $0.00 | $5,875.00 |
You are still in the Donut Hole. Your costs so far including the 2016 Coverage Gap Discount are $1,981.75. Your credit toward exiting the Coverage Gap is $3,264.25. | |||||||
$$ | 11: Nov | Donut Hole | $45.00 | $5.00 | $50.00 | $0.00 | $5,975.00 |
You are still in the Donut Hole. Your costs so far including the 2016 Coverage Gap Discount are $2,026.75. Your credit toward exiting the Coverage Gap is $3,359.25. | |||||||
$$ | 12: Dec | Donut Hole | $45.00 | $5.00 | $50.00 | $0.00 | $6,075.00 |
You are still in the Donut Hole. Your costs so far including the 2016 Coverage Gap Discount are $2,071.75. Your credit toward exiting the Coverage Gap is $3,454.25. | |||||||
Summary |
Who Pays | Total Retail |
|||||
You | Plan | Mfgr | Gov | ||||
Totals without premium: | $2,071.75 | $2,620.75 | $1,382.50 | $0.00 | $6,075.00 | ||
Notes: *Copayments do not influence when you will enter and leave the Donut Hole (which is based on plan’s negotiated retail drug costs). It will only affect your out-of-pocket costs. **For plan years 2011 to 2024, the chart values include the Donut Hole Discount. Read Q&A about the Discount. ***Beginning with plan year 2024, the Inflation Reduction Act (IRA) of 2022 eliminates beneficiary cost-sharing once your TrOOP reaches the established maximum cap on out-of-pocket spending for Part D formulary drugs (RxMOOP). | |||||||
Legend: | |||||||
$$$ | 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 2016, your drug costs are also shared during the Coverage Gap. The plan pays 42% of your generic drug costs and the drug manufacturer pays 55% 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 $2.95 for generics or $7.4 for brand drugs (whichever is higher). |
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