2020 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: | |
0% Generic / 100% 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: | $2,666.83 |
2020 Donut Hole Calculation Details | |||||||
Month |
Plan Phase |
Who Pays | Total Retail |
||||
You | Plan | Mfgr | Gov | ||||
$$$ | 1: Jan | Deductible | $435.00 | $0.00 | $0.00 | $0.00 | $435.00 |
Your deductible is less than your Rx costs for the month, so here we will use the deductible of $435 and on the next line you will see your initial coverage costs for the remainder of this month. Your costs so far $435. | |||||||
$$ | 1: Jan | Initial Coverage | $91.25 | $273.75 | $0.00 | $0.00 | $800.00 |
You satisfied the remainder of your deductible ($435) earlier this month. Now, in the Initial Coverage phase, you pay 25% of the remaining Rx costs for the month ($365.00) (upto the initial coverage limit--ICL) and your plan pays 75%. Some plan offer copayments instead.* Your costs so far $526.25. | |||||||
$$ | 2: Feb | Initial Coverage | $200.00 | $600.00 | $0.00 | $0.00 | $1,600.00 |
You are in the Initial Coverage Phase. Your costs so far $726.25. | |||||||
$$ | 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 $926.25. | |||||||
$$ | 4: Apr | Initial Coverage | $200.00 | $600.00 | $0.00 | $0.00 | $3,200.00 |
You are in the Initial Coverage Phase. Your costs so far $1,126.25. | |||||||
$$ | 5: May | Initial Coverage | $200.00 | $600.00 | $0.00 | $0.00 | $4,000.00 |
You are in the Initial Coverage Phase. Your costs so far $1,326.25. | |||||||
$$ | 6: Jun | Initial Coverage | $5.00 | $15.00 | $0.00 | $0.00 | $4,020.00 |
You are in the Initial Coverage Phase. Your costs so far $1,331.25. | |||||||
$$ | 6: Jun | Donut Hole | $195.00 | $39.00 | $546.00 | $0.00 | $4,800.00 |
You entered the Coverage Gap (Donut Hole) in June. Your costs so far including the 2020 Coverage Gap Discount are $1,526.25. Your credit toward exiting the Coverage Gap is $2,072.25. This includes what you spent plus what the brand-name drug manufacturer (Mfgr) spent on your behalf. For plan year 2020, Non-LIS Medicare Beneficiaries get a 75% discount on generics and a 75% discount on brand-name drugs purchased in the Coverage Gap. Read Q&A about the Discount... | |||||||
$$ | 7: Jul | Donut Hole | $200.00 | $40.00 | $560.00 | $0.00 | $5,600.00 |
You are still in the Donut Hole. Your costs so far including the 2020 Coverage Gap Discount are $1,726.25. Your credit toward exiting the Coverage Gap is $2,832.25. | |||||||
$$ | 8: Aug | Donut Hole | $200.00 | $40.00 | $560.00 | $0.00 | $6,400.00 |
You are still in the Donut Hole. Your costs so far including the 2020 Coverage Gap Discount are $1,926.25. Your credit toward exiting the Coverage Gap is $3,592.25. | |||||||
$$ | 9: Sep | Donut Hole | $200.00 | $40.00 | $560.00 | $0.00 | $7,200.00 |
You are still in the Donut Hole. Your costs so far including the 2020 Coverage Gap Discount are $2,126.25. Your credit toward exiting the Coverage Gap is $4,352.25. | |||||||
$$ | 10: Oct | Donut Hole | $200.00 | $40.00 | $560.00 | $0.00 | $8,000.00 |
You are still in the Donut Hole. Your costs so far including the 2020 Coverage Gap Discount are $2,326.25. Your credit toward exiting the Coverage Gap is $5,112.25. | |||||||
$$ | 11: Nov | Donut Hole | $200.00 | $40.00 | $560.00 | $0.00 | $8,800.00 |
You are still in the Donut Hole. Your costs so far including the 2020 Coverage Gap Discount are $2,526.25. Your credit toward exiting the Coverage Gap is $5,872.25. | |||||||
$$ | 12: Dec | Donut Hole | $125.72 | $25.14 | $352.03 | $0.00 | $9,302.89 |
You are still in the Donut Hole. Your costs so far including the 2020 Coverage Gap Discount are $2,651.97. Your credit toward exiting the Coverage Gap is $6,350.00. | |||||||
$ | 12: Dec | Catastrophic Coverage | $14.86 | $44.57 | $0.00 | $237.68 | $9,600.00 |
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 $3.60 for generics, $8.95 for brands or 5% whichever is higher. Your costs so far $2,666.83. | |||||||
Summary |
Who Pays | Total Retail |
|||||
You | Plan | Mfgr | Gov | ||||
Totals without premium: | $2,666.83 | $2,997.46 | $3,698.03 | $237.68 | $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 2020, your drug costs are also shared during the Coverage Gap. The plan pays 75% of your generic drug costs and the drug manufacturer pays 75% 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 $3.60 for generics or $8.95 for brand drugs (whichever is higher). |
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