2023 Donut Hole Calculation Summary: | |
Summary of the annual retail cost of your drugs:
|
|
Percentage of Generic vs. Brand drug purchases used: | |
0% Generic / 100% Brand (not vaccine adjusted) | |
You will enter the Coverage Gap (Donut Hole): | in January |
You will exit the Coverage Gap (Donut Hole): | in January |
Your total annual Out-of-Pocket Costs without premium: | $3,494.63 |
2023 Donut Hole Calculation Details | |||||||
Month |
Plan Phase |
Who Pays | Total Retail |
||||
You | Plan | Mfgr | Gov | ||||
$$ | 1: Jan | Initial Coverage | $1,165.00 | $3,495.00 | $0.00 | $0.00 | $4,660.00 |
You are in the Initial Coverage Phase. Your costs so far $1,165.00. | |||||||
$$ | 1: Jan | Donut Hole | $1,640.79 | $328.16 | $4,594.21 | $0.00 | $11,223.16 |
You entered the Coverage Gap (Donut Hole) in January. Your costs so far including the 2023 Coverage Gap Discount are $2,805.79. Your credit toward exiting the Coverage Gap is $7,400.00. This includes what you spent plus what the brand-name drug manufacturer (Mfgr) spent on your behalf. For plan year 2023, 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... | |||||||
$ | 1: Jan | Catastrophic Coverage | $688.84 | $2,066.53 | $0.00 | $11,021.47 | $25,000.00 |
You exited the Coverage Gap (Donut Hole) in January and are now in the catastrophic coverage. We have used 5% to calculate your costs.
The actual calculation is $4.15 for generics, $10.35 for brands or 5% whichever is higher. Your costs so far $3,494.63. | |||||||
$ | 2: Feb | Catastrophic Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $25,000.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,494.63. | |||||||
$ | 3: Mar | Catastrophic Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $25,000.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,494.63. | |||||||
$ | 4: Apr | Catastrophic Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $25,000.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,494.63. | |||||||
$ | 5: May | Catastrophic Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $25,000.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,494.63. | |||||||
$ | 6: Jun | Catastrophic Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $25,000.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,494.63. | |||||||
$ | 7: Jul | Catastrophic Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $25,000.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,494.63. | |||||||
$ | 8: Aug | Catastrophic Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $25,000.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,494.63. | |||||||
$ | 9: Sep | Catastrophic Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $25,000.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,494.63. | |||||||
$ | 10: Oct | Catastrophic Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $25,000.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,494.63. | |||||||
$ | 11: Nov | Catastrophic Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $25,000.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,494.63. | |||||||
$ | 12: Dec | Catastrophic Coverage | $0.00 | $0.00 | $0.00 | $0.00 | $25,000.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $3,494.63. | |||||||
Summary |
Who Pays | Total Retail |
|||||
You | Plan | Mfgr | Gov | ||||
Totals without premium: | $3,494.63 | $5,889.68 | $4,594.21 | $11,021.47 | $25,000.00 | ||
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 2023, 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... |
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$ | You pay a small fraction of your prescription (Rx) costs. This occurs in Catastrophic Coverage. You pay 5% of your medication costs or $4.15 for generics or $10.35 for brand drugs (whichever is higher). |
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