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Do you have a Donut Hole calculator or a way to estimate my annual Medicare Part D spending?

Yes.  Our Medicare Part D Donut Hole Calculator or PDP-Planner is designed so seniors and other Medicare beneficiaries can see how their Part D drug spending could change throughout the year and help estimate annual drug costs.

You can find a link to our Donut Hole Calculator in either the right-hand margin or left-hand navigation (when using the full screed, desktop view).  If you are using a smaller screen or mobile device, you can enter https://PDP-Planner.com.

Q1Medicare Medicare Part D Donut Hole Calculator

Once on the PDP-Planner / Donut Hole Calculator page, you can begin by:

(1) entering your average monthly Medicare Part D retail drug costs,
(2) choose the month when your drug plan coverage began (usually January),
(3) change your plan's Initial Deductible (if you wish), and
(4) choose your approximate mix of generic or brand-name drugs.

Medicare Part D Donut Hole Calculator - Example 1

How do I estimate my Medicare Part D plan's retail drug prices?

You can estimate your retail drug costs using our Q1Rx Drug Finder found at Q1Rx.com.

Just enter the name of your formulary drug, location, and see the average retail prices across all Medicare Part D drug plans in your area (standard and preferred network retail pricing can vary).  Your actual retail drug costs should also be found within your plan's "Explanation of Benefits" letter that you receive every month.

Q1Rx Drug Finder showing retail cost and co-pays for formulary drug

Finally, click on the green "Get Report" button found at the bottom.

To help you visualize your potential drug spending, we show a chart of how your estimated annual drug costs are organized by month and within the four parts of your Medicare Part D plan coverage (Initial Deductible, Initial Coverage Phase, Coverage Gap (or Donut Hole), and Catastrophic Coverage).  If you have a $0 deductible, you will naturally skip over the first part of coverage and begin directly in the Initial Coverage Phase.

Our PDP-Planner tool or Donut Hole Calculator uses the annual Centers for Medicare and Medicaid Services (CMS) defined standard Medicare Part D prescription drug plan benefit parameters (assuming a 25% co-insurance as cost-sharing during the Initial Coverage Phase), the annual Donut Hole discount, and even calculates your "straddle claims" -- drug purchases that cross over more than one drug plan coverage phase.  The results of the Donut Hole Calculator can be sent directly to your email account, printed, or viewed online.

We even have older versions of our Donut Hole calculators online in our "Plan Archives" section if you wanted to see how your estimated Medicare Part D spending might have changed over the years.

How about an example?

To get started, we provide several Donut Hole or Coverage Gap examples with links at the top of the page.  You can click here for an example of a Medicare beneficiary with relatively high monthly prescription drug costs (retail drug costs averaging $800 per month), an initial deductible of $480 (the standard 2022 deductible), and we chose to have all of the $800 drug costs are for brand-name formulary medications (0% Generic / 100% Brand).

Right under the example, you can see that this Medicare beneficiary can anticipate entering the Donut Hole or Coverage Gap in June 2022 when their Initial Coverage Limit of $4,430 is exceeded.

With monthly retail drug costs of $800, this same person can expect end the year in the 2022 Donut Hole. They will not enter the Catastrophic Coverage phase which happens when their True or total out-of-pocket costs (TrOOP) exceeds $7,050.

In our example, this person’s total annual out-of-pocket drug expenses would be approximately $2,760.

Again, we are assuming coverage began in January - and the Medicare Part D plan included the standard 25% co-insurance rate during the person's Initial Coverage Phase - and 100% of the brand drugs purchased in the Donut Hole received the 75% Donut Hole discount - with 95% of the retail drug costs during the Donut Hole applying to TrOOP.

As a summary, an overview chart shows how this person's drug costs change month-to-month based on the phases or parts of their Medicare Part D plan coverage.

Details of Medicare Part D Donut Hole Calculator Example 1

If you wish, you can change the $800 value in our example to your own prescription spending - change the deductible (which is set at $0 by default) - and choose your mix of generic or brand-name drugs to see a preview of your own Medicare Part D drug coverage.

Still not sure what all these numbers mean to you or need a little extra help? No problem, click here and let us know.


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Tips & Disclaimers
  • 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 PDP-Compare.com and MA-Compare.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.
  • 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.