q1medicare.com
Powered by Q1Group LLC
A non-government resource for the Medicare community
Powered by Q1Group LLC
A non-government Medicare community resource
  • Menu ☰
  • Home
  • Contact
  • MAPD
  • PDP
  • 2025
  • FAQs
  • Articles
  • Search ⌕
  • Contact
  • 2025
  • FAQs
  • Articles
  • Latest Medicare News
  • Search ⌕

2018 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.
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 2018 standard deductible is $405.
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

2018 Donut Hole Calculation Summary:
Summary of the annual retail cost of your drugs:
  • monthly retail: $0.00 x 12 = $0.00
  • quarterly retail: $2,400.00 x 4 = $9,600.00
  • semi-annual retail: $0.00 x 2 = $0.00
  • annual retail: $0.00 x 1 = $0.00
  • total retail of $9,600.00 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): in October
Your total annual Out-of-Pocket Costs without premium: $2,860.37

2018 Donut Hole Calculation Details

Month
Plan Phase		 Who Pays Total
Retail
You Plan Mfgr Gov
$$$1: JanDeductible $405.00 $0.00 $0.00 $0.00 $405.00
Your deductible is less than your Rx costs for the month, so here we will use the deductible of $405 and on the next line you will see your initial coverage costs for the remainder of this month. Your costs so far $405.
$$1: JanInitial Coverage $498.75 $1,496.25 $0.00 $0.00 $2,400.00
You satisfied the remainder of your deductible ($405) earlier this month. Now, in the Initial Coverage phase, you pay 25% of the remaining Rx costs for the month ($1,995.00) (upto the initial coverage limit--ICL) and your plan pays 75%. Some plan offer copayments instead.* Your costs so far $903.75.
$$2: FebInitial Coverage $0.00 $0.00 $0.00 $0.00 $2,400.00
You are in the Initial Coverage Phase. Your costs so far $903.75.
$$3: MarInitial Coverage $0.00 $0.00 $0.00 $0.00 $2,400.00
You are in the Initial Coverage Phase. Your costs so far $903.75.
$$4: AprInitial Coverage $337.50 $1,012.50 $0.00 $0.00 $3,750.00
You are in the Initial Coverage Phase. Your costs so far $1,241.25.
$$4: AprDonut Hole $367.50 $157.50 $525.00 $0.00 $4,800.00
You entered the Coverage Gap (Donut Hole) in April.
Your costs so far including the 2018 Coverage Gap Discount are $1,608.75. Your credit toward exiting the Coverage Gap is $2,133.75. This includes what you spent plus what the brand-name drug manufacturer (Mfgr) spent on your behalf. For plan year 2018, Non-LIS Medicare Beneficiaries get a 56% discount on generics and a 65% discount on brand-name drugs purchased in the Coverage Gap. Read Q&A about the Discount...
$$5: MayDonut Hole $0.00 $0.00 $0.00 $0.00 $4,800.00
You are still in the Donut Hole. Your costs so far including the 2018 Coverage Gap Discount are $1,608.75. Your credit toward exiting the Coverage Gap is $2,133.75.
$$6: JunDonut 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 2018 Coverage Gap Discount are $1,608.75. Your credit toward exiting the Coverage Gap is $2,133.75.
$$7: JulDonut Hole $840.00 $360.00 $1,200.00 $0.00 $7,200.00
You are still in the Donut Hole. Your costs so far including the 2018 Coverage Gap Discount are $2,448.75. Your credit toward exiting the Coverage Gap is $4,173.75.
$$8: AugDonut Hole $0.00 $0.00 $0.00 $0.00 $7,200.00
You are still in the Donut Hole. Your costs so far including the 2018 Coverage Gap Discount are $2,448.75. Your credit toward exiting the Coverage Gap is $4,173.75.
$$9: SepDonut Hole $0.00 $0.00 $0.00 $0.00 $7,200.00
You are still in the Donut Hole. Your costs so far including the 2018 Coverage Gap Discount are $2,448.75. Your credit toward exiting the Coverage Gap is $4,173.75.
$$10: OctDonut Hole $340.22 $145.81 $486.03 $0.00 $8,172.06
You are still in the Donut Hole. Your costs so far including the 2018 Coverage Gap Discount are $2,788.97. Your credit toward exiting the Coverage Gap is $5,000.00.
$10: OctCatastrophic Coverage $71.40 $214.19 $0.00 $1,142.35 $9,600.00
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 $3.35 for generics, $8.35 for brands or 5% whichever is higher.
Your costs so far $2,860.37.
$11: NovCatastrophic 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 $2,860.37.
$12: DecCatastrophic 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 $2,860.37.

Summary		 Who Pays Total
Retail
You Plan Mfgr Gov
Totals without premium: $2,860.37 $3,386.25 $2,211.03 $1,142.35 $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 2018, your drug costs are also shared during the Coverage Gap. The plan pays 56% of your generic drug costs and the drug manufacturer pays 65% 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 $3.35 for generics or $8.35 for brand drugs (whichever is higher).



If you would like to receive a copy of this report via email, please enter your email address:

Please note, your email address will not be shared with any third parties - Your privacy is important to us!

  I also want to be added to your free Medicare Part D email newsletter group






Calculators Available:

PDP-Planner Calculators:
2025 | 2024 | 2023 | 2022 | 2021 | 2020 | 2019 | 2018 | 2017 | 2016 | 2015 | 2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006



Free Newsletter

Sign-up for our FREE newsletter below, to be kept informed of the latest changes!
Newsletter sign-up

SPAM filter activated? To ensure that you receive our newsletter, please add team@q1group.com to your SPAM filter whitelist, contact list, sender list, and/or address book



This Q1Medicare.com Doughnut Hole calculator is based on the 2018 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.


Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs





Pets are Family Too!
Use your drug discount card to save on medications for the entire family ‐ including your pets.

» Learn more about savings on Pet Medications
  • No enrollment fee and no limits on usage
  • Everyone in your household can use the same card, including your pets
Your drug discount card is available to you at no cost.


© Q1Group LLC 2005 - 2025  



Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
.