Yes. If your retail drug costs are $347 a month you will enter your Medicare Part D plan's 2017 Coverage Gap or Donut Hole in late-October or early-November 2017.
As
a reminder . . .
You will enter
the Donut Hole or Coverage Gap when the total retail value of your formulary prescription
purchases exceeds your Medicare Part D plan's
Initial Coverage Limit. In
2017, the standard Initial Coverage Limit is $3,700.
So, if your prescriptions have an average retail cost of over
$308 per month (or a total retail cost over the
standard Initial Coverage Limit of $3,700 per year), you will enter the 2017 Donut Hole or Coverage Gap.
In this example, if you purchase a medication with a retail cost of $347 and your
Medicare Part D plan's co-pay is $47, the $347 retail cost will count toward meeting
your $3,700 Initial Coverage Limit - or Donut Hole entry point and the $47 you spent will count
toward your out-of-pocket limit (
TrOOP) of $4,950 - or Donut Hole exit point.
You can use the chart below to see how your average monthly retail drug costs would affect when you enter the Donut Hole.
Minimum
Average Monthly Retail Drug Cost
Causing You to Enter the Donut Hole in a
Given Month
|
You will enter
the Donut Hole in . . .
|
If your 2017
monthly retail drug
costs are over . . .
|
If your 2016
monthly retail drug
costs are over . . . |
January |
$3,700 |
$3,310 |
February |
$1,850 |
$1,655 |
March |
$1,234 |
$1,104 |
April |
$925 |
$828 |
May |
$740 |
$662 |
June |
$617 |
$552 |
July |
$529 |
$473 |
August |
$463 |
$414 |
September |
$412 |
$368 |
October |
$370 |
$331 |
November |
$337 |
$301 |
December |
$309 |
$276 |
The good news . . .
If the retail prices of your prescription
drugs have not changed since 2016, then your 2017 Donut Hole or Coverage Gap should start
just slightly later, since the
2017 Initial Coverage Limit is slightly higher than
the 2016 Initial Coverage Limit of $3,310. You can see in the chart below when you would enter the Donut Hole in 2016 or 2017.
And once you reach the 2017 Donut Hole or Coverage Gap . . .
In 2017, you receive a 60%
Donut Hole discount on brand-name drugs (you pay 40% of your plan's negotiated retail cost for brand-name prescriptions) and a 49% discount on generic drugs (you pay 51% of the retail cost for generics).
So if you are using a brand-name drug that has a $347 retail cost, you will pay 40% of the retail price or 0.40 * ($347) =
$139 once you reach the 2017 Donut Hole.
You can read more here: "What kind of discount can we expect in the Medicare Part D Donut Hole or Coverage Gap?"
https://Q1FAQ.com/470.html
Will I also exit the 2017 Donut Hole with this $347 drug?
No. Again, if the
retail cost of your medications is over
$309 each month, you will enter the Donut Hole sometime in
2017. For example, if the monthly average retail value
of your prescriptions is over
$617, you will enter the Donut Hole in June.
However, you would need average monthly retail drug costs of around
$621 to $675 before meeting your
$4,950 TrOOP limit and exiting the 2017 Donut Hole (depending on your mix of brand-name and generic drugs).