You will pay
$100 in the Donut Hole or Coverage Gap and
$12.50 in the Catastrophic Coverage phase for a brand-name drug with a $250 retail value.
Once the total retail value of your Medicare Part D drug purchases exceeds your
Initial Coverage Limit of
$3,700, you will enter the 2017 Donut Hole or Coverage Gap and pay
40% of the retail price for your brand-name medications – assuming that your Medicare prescription drug plan
does not provide any coverage in the Donut Hole.
However, you will get a credit of 90% of the retail cost ($225) toward meeting your annual total out-of-pocket limit (
TrOOP) of $4,950.
If you exceed the
$4,950 out-of-pocket limit, you will reach the 2017 Catastrophic Coverage phase of your Medicare Part D plan and pay the higher of $8.25 or 5% of the brand-name retail drug price.
So if you reach the Catastrophic Coverage portion of your Medicare Part D plan, you will pay $12.50 ($250 x 0.05) for a $250 brand-name medication (since $12.50 is greater than the $8.25 minimum).
As a reminder: You can use our Drug Finder (
Q1Rx.com) to see the average retail cost of any medication covered by your Medicare prescription drug plan.
But remember, your actual negotiated retail drug prices can vary pharmacy-to-pharmacy and even week-to-week at the same pharmacy.