You will pay $112.50
in the Donut Hole and $12.50 in the Catastrophic Coverage phase.
Once the total retail value of your 2016 Medicare
Part D drug purchases exceed
$3,310,
you will enter the 2016 Donut Hole or Coverage Gap and
pay
45% 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
95% of the retail cost toward meeting your total out-of-pocket limit of $4,850.
This means that if you reach the 2016 Donut Hole and purchase a $250 brand-name
medication, you will receive a
55%
drug discount, pay $112.50, and get 95% of the retail price or $237.50
credited toward meeting your $4,850 out-of-pocket limit.
If you exceed the $4,850 out-of-pocket limit, you will reach the 2016
Catastrophic Coverage phase of your Medicare Part D plan and pay the higher of
$7.40 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 for a $250 brand-name
medication.
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,
actual negotiated retail drug prices can vary pharmacy-to-pharmacy and
week-to-week.