2017 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): | in October |
Your total annual Out-of-Pocket Costs without premium: | $2,968.61 |
2017 Donut Hole Calculation Details | |||||||
Month |
Plan Phase |
Who Pays | Total Retail |
||||
You | Plan | Mfgr | Gov | ||||
$$$ | 1: Jan | Deductible | $400.00 | $0.00 | $0.00 | $0.00 | $400.00 |
Your deductible is less than your Rx costs for the month, so here we will use the deductible of $400 and on the next line you will see your initial coverage costs for the remainder of this month. Your costs so far $400. | |||||||
$$ | 1: Jan | Initial Coverage | $100.00 | $300.00 | $0.00 | $0.00 | $800.00 |
You satisfied the remainder of your deductible ($400) earlier this month. Now, in the Initial Coverage phase, you pay 25% of the remaining Rx costs for the month ($400.00) (upto the initial coverage limit--ICL) and your plan pays 75%. Some plan offer copayments instead.* Your costs so far $500.00. | |||||||
$$ | 2: Feb | Initial Coverage | $200.00 | $600.00 | $0.00 | $0.00 | $1,600.00 |
You are in the Initial Coverage Phase. Your costs so far $700.00. | |||||||
$$ | 3: Mar | Initial Coverage | $200.00 | $600.00 | $0.00 | $0.00 | $2,400.00 |
You are in the Initial Coverage Phase. Your costs so far $900.00. | |||||||
$$ | 4: Apr | Initial Coverage | $200.00 | $600.00 | $0.00 | $0.00 | $3,200.00 |
You are in the Initial Coverage Phase. Your costs so far $1,100.00. | |||||||
$$ | 5: May | Initial Coverage | $125.00 | $375.00 | $0.00 | $0.00 | $3,700.00 |
You are in the Initial Coverage Phase. Your costs so far $1,225.00. | |||||||
$$ | 5: May | Donut Hole | $120.00 | $30.00 | $150.00 | $0.00 | $4,000.00 |
You entered the Coverage Gap (Donut Hole) in May. Your costs so far including the 2017 Coverage Gap Discount are $1,345.00. Your credit toward exiting the Coverage Gap is $1,495.00. This includes what you spent plus what the brand-name drug manufacturer (Mfgr) spent on your behalf. For plan year 2017, Non-LIS Medicare Beneficiaries get a 49% discount on generics and a 60% discount on brand-name drugs purchased in the Coverage Gap. Read Q&A about the Discount... | |||||||
$$ | 6: Jun | Donut Hole | $320.00 | $80.00 | $400.00 | $0.00 | $4,800.00 |
You are still in the Donut Hole. Your costs so far including the 2017 Coverage Gap Discount are $1,665.00. Your credit toward exiting the Coverage Gap is $2,215.00. | |||||||
$$ | 7: Jul | Donut Hole | $320.00 | $80.00 | $400.00 | $0.00 | $5,600.00 |
You are still in the Donut Hole. Your costs so far including the 2017 Coverage Gap Discount are $1,985.00. Your credit toward exiting the Coverage Gap is $2,935.00. | |||||||
$$ | 8: Aug | Donut Hole | $320.00 | $80.00 | $400.00 | $0.00 | $6,400.00 |
You are still in the Donut Hole. Your costs so far including the 2017 Coverage Gap Discount are $2,305.00. Your credit toward exiting the Coverage Gap is $3,655.00. | |||||||
$$ | 9: Sep | Donut Hole | $320.00 | $80.00 | $400.00 | $0.00 | $7,200.00 |
You are still in the Donut Hole. Your costs so far including the 2017 Coverage Gap Discount are $2,625.00. Your credit toward exiting the Coverage Gap is $4,375.00. | |||||||
$$ | 10: Oct | Donut Hole | $255.56 | $63.89 | $319.44 | $0.00 | $7,838.89 |
You are still in the Donut Hole. Your costs so far including the 2017 Coverage Gap Discount are $2,880.56. Your credit toward exiting the Coverage Gap is $4,950.00. | |||||||
$ | 10: Oct | Catastrophic Coverage | $8.06 | $24.17 | $0.00 | $128.89 | $8,000.00 |
You exited the Coverage Gap (Donut Hole) in October and are now in the catastrophic coverage. We have used 5% to calculate your costs.
The actual calculation is $3.30 for generics, $8.25 for brands or 5% whichever is higher. Your costs so far $2,888.61. | |||||||
$ | 11: Nov | Catastrophic Coverage | $40.00 | $120.00 | $0.00 | $640.00 | $8,800.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $2,928.61. | |||||||
$ | 12: Dec | Catastrophic Coverage | $40.00 | $120.00 | $0.00 | $640.00 | $9,600.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $2,968.61. | |||||||
Summary |
Who Pays | Total Retail |
|||||
You | Plan | Mfgr | Gov | ||||
Totals without premium: | $2,968.61 | $3,153.06 | $2,069.44 | $1,408.89 | $9,600.00 | ||
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 2017, your drug costs are also shared during the Coverage Gap. The plan pays 49% of your generic drug costs and the drug manufacturer pays 60% 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 $3.30 for generics or $8.25 for brand drugs (whichever is higher). |
SPAM filter activated? To ensure that your receive our newsletter, please add
team@q1group.com to your SPAM filter whitelist,
contact list, sender list, and/or address book