Will you enter the Coverage Gap or Donut Hole this year?

You can determine when (or if) you will enter the Donut Hole or Coverage Gap by just dividing your Medicare Part D prescription drug plan's Initial Coverage Limit by 12 months and you will get the retail value of prescription drugs you need to purchase per month before entering the Donut Hole at some time during that year.

In 2013, the standard Initial Coverage Limit is $2,970, so if your prescription drugs have a retail value of over $247.50 per month, then you would enter into the 2013 Coverage Gap or Donut Hole.

As a past example, you would have entered the 2009 Donut Hole when your total retail prescription costs exceed the 2009 Initial Coverage Limit of $2,700 in one year. This means that if your 2009 monthly retail prescription drug costs were over $225 per month, you would go into the Donut Hole some time before the end of 2009.

Here is a short list of popular brand name medications from 2009 and their approximate retail price to give you an idea of how easy it was for the total cost of your prescriptions to reach a retail value of over $225 per month (the actual 2009 negotiated retail price for each drug would vary slightly with your Medicare Part D plan):

Brand Names ®	Form / Strength	2009 Retail Cost
Actonel ®	Tab 35 MG	$89
Advair Disc ®	MIS 250/50	$200
Ambien ®	Tab 10 MG	$154
Diovan ®	Tab 80 MG	$68
Lipitor ®	Tab 10 MG	$85
Lotrel ®	Cap 5-20 MG	$97
Nexium ®	Cap 40 MG	$162
Norvasc ®	Tab 10 MG	$80
Plavix ®	Tab 75 MG	$145
Prevacid ®	Cap 30 MG DR	$158
Zocor ®	Tab 20 MG	$147
Zoloft ®	Tab 100 MG	$101

So if the retail cost of your 2009 formulary medications averaged over $338 per month you would see from our PDP-Planner tool that you would have expected to be in the 2009 Doughnut Hole by the end of August 2009.

Do you still have questions about how the Coverage Gap or Doughnut Hole works with your Medicare prescription drug plan? No problem, just click here and we will try to answer your question.