2018 Donut Hole Calculation Summary: | |
Summary of the annual retail cost of your drugs:
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Percentage of Generic vs. Brand drug purchases used: | |
10.82% Generic / 89.18% Brand (not vaccine adjusted) | |
You will enter the Coverage Gap (Donut Hole): | in June |
You will exit the Coverage Gap (Donut Hole): | in December |
Your total annual Out-of-Pocket Costs without premium: | $2,919.73 |
2018 Donut Hole Calculation Details | |||||||
Month |
Plan Phase |
Who Pays | Total Retail |
||||
You | Plan | Mfgr | Gov | ||||
$$$ | 1: Jan | Deductible | $405.00 | $0.00 | $0.00 | $0.00 | $405.00 |
Your deductible is less than your Rx costs for the month, so here we will use the deductible of $405 and on the next line you will see your initial coverage costs for the remainder of this month. Your costs so far $405. | |||||||
$$ | 1: Jan | Initial Coverage | $74.12 | $222.35 | $0.00 | $0.00 | $701.47 |
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 ($296.47) (upto the initial coverage limit--ICL) and your plan pays 75%. Some plan offer copayments instead.* Your costs so far $479.12. | |||||||
$$ | 2: Feb | Initial Coverage | $175.37 | $526.10 | $0.00 | $0.00 | $1,402.93 |
You are in the Initial Coverage Phase. Your costs so far $654.48. | |||||||
$$ | 3: Mar | Initial Coverage | $175.37 | $526.10 | $0.00 | $0.00 | $2,104.40 |
You are in the Initial Coverage Phase. Your costs so far $829.85. | |||||||
$$ | 4: Apr | Initial Coverage | $175.37 | $526.10 | $0.00 | $0.00 | $2,805.87 |
You are in the Initial Coverage Phase. Your costs so far $1,005.22. | |||||||
$$ | 5: May | Initial Coverage | $175.37 | $526.10 | $0.00 | $0.00 | $3,507.33 |
You are in the Initial Coverage Phase. Your costs so far $1,180.58. | |||||||
$$ | 6: Jun | Initial Coverage | $60.67 | $182.00 | $0.00 | $0.00 | $3,750.00 |
You are in the Initial Coverage Phase. Your costs so far $1,241.25. | |||||||
$$ | 6: Jun | Donut Hole | $165.05 | $89.17 | $204.58 | $0.00 | $4,208.80 |
You entered the Coverage Gap (Donut Hole) in June. Your costs so far including the 2018 Coverage Gap Discount are $1,406.30. Your credit toward exiting the Coverage Gap is $1,610.88. 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... | |||||||
$$ | 7: Jul | Donut Hole | $252.34 | $136.34 | $312.78 | $0.00 | $4,910.27 |
You are still in the Donut Hole. Your costs so far including the 2018 Coverage Gap Discount are $1,658.64. Your credit toward exiting the Coverage Gap is $2,176.00. | |||||||
$$ | 8: Aug | Donut Hole | $252.34 | $136.34 | $312.78 | $0.00 | $5,611.73 |
You are still in the Donut Hole. Your costs so far including the 2018 Coverage Gap Discount are $1,910.99. Your credit toward exiting the Coverage Gap is $2,741.13. | |||||||
$$ | 9: Sep | Donut Hole | $252.34 | $136.34 | $312.78 | $0.00 | $6,313.20 |
You are still in the Donut Hole. Your costs so far including the 2018 Coverage Gap Discount are $2,163.33. Your credit toward exiting the Coverage Gap is $3,306.26. | |||||||
$$ | 10: Oct | Donut Hole | $252.34 | $136.34 | $312.78 | $0.00 | $7,014.67 |
You are still in the Donut Hole. Your costs so far including the 2018 Coverage Gap Discount are $2,415.67. Your credit toward exiting the Coverage Gap is $3,871.39. | |||||||
$$ | 11: Nov | Donut Hole | $252.34 | $136.34 | $312.78 | $0.00 | $7,716.13 |
You are still in the Donut Hole. Your costs so far including the 2018 Coverage Gap Discount are $2,668.02. Your credit toward exiting the Coverage Gap is $4,436.52. | |||||||
$$ | 12: Dec | Donut Hole | $251.61 | $135.94 | $311.87 | $0.00 | $8,415.56 |
You are still in the Donut Hole. Your costs so far including the 2018 Coverage Gap Discount are $2,919.63. Your credit toward exiting the Coverage Gap is $5,000.00. | |||||||
$ | 12: Dec | Catastrophic Coverage | $0.10 | $0.31 | $0.00 | $1.63 | $8,417.60 |
You exited the Coverage Gap (Donut Hole) in December 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 $2,919.73. | |||||||
Summary |
Who Pays | Total Retail |
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You | Plan | Mfgr | Gov | ||||
Totals without premium: | $2,919.73 | $3,415.86 | $2,080.37 | $1.63 | $8,417.60 | ||
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... |
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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 $3.35 for generics or $8.35 for brand drugs (whichever is higher). |
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