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2017 PDP-Planner:
Medicare Part D Donut 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.
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 2017 standard deductible is $400.
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

2017 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 July
You will exit the Coverage Gap (Donut Hole): with start of new plan year
Your total annual Out-of-Pocket Costs without premium: $1,875.00


2017 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 $125.00 $375.00 $0.00 $0.00 $3,275.00
You are in the Initial Coverage Phase. Your costs so far $818.75.
$$5: MayInitial Coverage $25.00 $75.00 $0.00 $0.00 $3,375.00
You are in the Initial Coverage Phase. Your costs so far $843.75.
$$6: JunInitial Coverage $25.00 $75.00 $0.00 $0.00 $3,475.00
You are in the Initial Coverage Phase. Your costs so far $868.75.
$$7: JulInitial Coverage $56.25 $168.75 $0.00 $0.00 $3,700.00
You are in the Initial Coverage Phase. Your costs so far $925.00.
$$7: JulDonut Hole $590.00 $147.50 $737.50 $0.00 $5,175.00
You entered the Coverage Gap (Donut Hole) in July.
Your costs so far including the 2017 Coverage Gap Discount are $1,515.00. Your credit toward exiting the Coverage Gap is $2,252.50. 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...
$$8: AugDonut Hole $40.00 $10.00 $50.00 $0.00 $5,275.00
You are still in the Donut Hole. Your costs so far including the 2017 Coverage Gap Discount are $1,555.00. Your credit toward exiting the Coverage Gap is $2,342.50.
$$9: SepDonut Hole $40.00 $10.00 $50.00 $0.00 $5,375.00
You are still in the Donut Hole. Your costs so far including the 2017 Coverage Gap Discount are $1,595.00. Your credit toward exiting the Coverage Gap is $2,432.50.
$$10: OctDonut Hole $200.00 $50.00 $250.00 $0.00 $5,875.00
You are still in the Donut Hole. Your costs so far including the 2017 Coverage Gap Discount are $1,795.00. Your credit toward exiting the Coverage Gap is $2,882.50.
$$11: NovDonut Hole $40.00 $10.00 $50.00 $0.00 $5,975.00
You are still in the Donut Hole. Your costs so far including the 2017 Coverage Gap Discount are $1,835.00. Your credit toward exiting the Coverage Gap is $2,972.50.
$$12: DecDonut Hole $40.00 $10.00 $50.00 $0.00 $6,075.00
You are still in the Donut Hole. Your costs so far including the 2017 Coverage Gap Discount are $1,875.00. Your credit toward exiting the Coverage Gap is $3,062.50.

Summary
Who Pays Total
Retail
You Plan Mfgr Gov
Totals without premium: $1,875.00 $3,012.50 $1,187.50 $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 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).



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This Q1Medicare.com Doughnut Hole calculator is based on the 2017 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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