2021 PDP-Planner:
Medicare Part D Donut Hole Calculator

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.
But isn’t the Coverage Gap (Donut Hole) closed?

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:*

CMS estimated standard 10.50% Generic / 89.50% Brand (vaccine adjusted) 10.50% Generic / 89.50% Brand (not vaccine adjusted) 0% Generic / 100% Brand (not vaccine adjusted) 25% Generic / 75% Brand (not vaccine adjusted) 50% Generic / 50% Brand (not vaccine adjusted) 75% Generic / 25% Brand (not vaccine adjusted) 100% Generic / 0% Brand (not vaccine adjusted) No factor 100% Responsible in Gap

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 2021 standard deductible is $445.

Choose the your coverage start month - usually January:*

January February March April May June July August September October November December

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

2021 Donut Hole Calculation Summary:
Summary of the annual retail cost of your drugs: monthly retail: $837.37 x 12 = $10,048.39 quarterly retail: $0.00 x 4 = $0.00 semi-annual retail: $0.00 x 2 = $0.00 annual retail: $0.00 x 1 = $0.00 total retail of $10,048.39 to be used over 12 months of coverage
Percentage of Generic vs. Brand drug purchases used:
10.50% Generic / 89.50% Brand (not vaccine adjusted)
You will enter the Coverage Gap (Donut Hole):	in May
You will exit the Coverage Gap (Donut Hole):	in December
Your total annual Out-of-Pocket Costs without premium:	$2,845.00

2021 Donut Hole Calculation Details
	Month	Plan Phase	Who Pays				Total Retail
			You	Plan	Mfgr	Gov
$$$	1: Jan	Deductible	$445.00	$0.00	$0.00	$0.00	$445.00
Your deductible is less than your Rx costs for the month, so here we will use the deductible of $445 and on the next line you will see your initial coverage costs for the remainder of this month. Your costs so far $445.
$$	1: Jan	Initial Coverage	$98.09	$294.27	$0.00	$0.00	$837.37
You satisfied the remainder of your deductible ($445) earlier this month. Now, in the Initial Coverage phase, you pay 25% of the remaining Rx costs for the month ($392.37) (upto the initial coverage limit--ICL) and your plan pays 75%. Some plan offer copayments instead.* Your costs so far $543.09.
$$	2: Feb	Initial Coverage	$209.34	$628.02	$0.00	$0.00	$1,674.73
You are in the Initial Coverage Phase. Your costs so far $752.43.
$$	3: Mar	Initial Coverage	$209.34	$628.02	$0.00	$0.00	$2,512.10
You are in the Initial Coverage Phase. Your costs so far $961.77.
$$	4: Apr	Initial Coverage	$209.34	$628.02	$0.00	$0.00	$3,349.46
You are in the Initial Coverage Phase. Your costs so far $1,171.12.
$$	5: May	Initial Coverage	$195.13	$585.40	$0.00	$0.00	$4,130.00
You are in the Initial Coverage Phase. Your costs so far $1,366.25.
$$	5: May	Donut Hole	$14.21	$7.02	$35.60	$0.00	$4,186.83
You entered the Coverage Gap (Donut Hole) in May. Your costs so far including the 2021 Coverage Gap Discount are $1,380.46. Your credit toward exiting the Coverage Gap is $1,416.06. This includes what you spent plus what the brand-name drug manufacturer (Mfgr) spent on your behalf. For plan year 2021, Non-LIS Medicare Beneficiaries get a 75% discount on generics and a 75% discount on brand-name drugs purchased in the Coverage Gap. Read Q&A about the Discount...
$$	6: Jun	Donut Hole	$209.34	$103.41	$524.61	$0.00	$5,024.20
You are still in the Donut Hole. Your costs so far including the 2021 Coverage Gap Discount are $1,589.80. Your credit toward exiting the Coverage Gap is $2,150.01.
$$	7: Jul	Donut Hole	$209.34	$103.41	$524.61	$0.00	$5,861.56
You are still in the Donut Hole. Your costs so far including the 2021 Coverage Gap Discount are $1,799.14. Your credit toward exiting the Coverage Gap is $2,883.96.
$$	8: Aug	Donut Hole	$209.34	$103.41	$524.61	$0.00	$6,698.93
You are still in the Donut Hole. Your costs so far including the 2021 Coverage Gap Discount are $2,008.48. Your credit toward exiting the Coverage Gap is $3,617.91.
$$	9: Sep	Donut Hole	$209.34	$103.41	$524.61	$0.00	$7,536.29
You are still in the Donut Hole. Your costs so far including the 2021 Coverage Gap Discount are $2,217.82. Your credit toward exiting the Coverage Gap is $4,351.87.
$$	10: Oct	Donut Hole	$209.34	$103.41	$524.61	$0.00	$8,373.66
You are still in the Donut Hole. Your costs so far including the 2021 Coverage Gap Discount are $2,427.16. Your credit toward exiting the Coverage Gap is $5,085.82.
$$	11: Nov	Donut Hole	$209.34	$103.41	$524.61	$0.00	$9,211.02
You are still in the Donut Hole. Your costs so far including the 2021 Coverage Gap Discount are $2,636.51. Your credit toward exiting the Coverage Gap is $5,819.77.
$$	12: Dec	Donut Hole	$208.28	$102.89	$521.95	$0.00	$10,044.15
You are still in the Donut Hole. Your costs so far including the 2021 Coverage Gap Discount are $2,844.79. Your credit toward exiting the Coverage Gap is $6,550.00.
$	12: Dec	Catastrophic Coverage	$0.21	$0.64	$0.00	$3.39	$10,048.39
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 $3.70 for generics, $9.2 for brands or 5% whichever is higher. Your costs so far $2,845.00.
Summary			Who Pays				Total Retail
			You	Plan	Mfgr	Gov
Totals without premium:			$2,845.00	$3,494.78	$3,705.21	$3.39	$10,048.39
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 2021, 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...
$	You pay a small fraction of your prescription (Rx) costs. This occurs in Catastrophic Coverage. You pay 5% of your medication costs or $3.70 for generics or $9.2 for brand drugs (whichever is higher).

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