Yes. Our Medicare Part D Donut Hole Calculator or PDP-Planner is designed so seniors and other Medicare beneficiaries can see how their Part D drug spending could change throughout the year and help estimate annual drug costs.
You can find a link to our Donut Hole Calculator in either the right-hand margin or left-hand navigation (when using the full screed, desktop view). If you are using a smaller screen or mobile device, you can enter https://PDP-Planner.com.
Once on the PDP-Planner / Donut Hole Calculator page, you can begin by: (1) entering your average monthly Medicare Part D retail drug costs, (2) choose the month when your drug plan coverage began (usually January), (3) change your plan's Initial Deductible (if you wish), and (4) choose your approximate mix of generic or brand-name drugs.
How do I estimate my plan's retail drug prices?
You can get estimate your retail drug costs
using our Drug Finder found at Q1Rx.com
. Just enter the name of your formulary drug, location, and see the retail prices across all Medicare Part D drug plans in your area. Your retail drug costs should also be found on your plan's "Explanation of Benefits" letter that you receive every month.
Finally, click on the green "Get Report" button.
To help you visualize your potential drug spending, we show a chart of how your estimated annual drug costs are organized by month and within the four parts of your Medicare Part D plan coverage (Initial Deductible, Initial Coverage Phase, Coverage Gap (or Donut Hole), and Catastrophic Coverage). If you have a $0 deductible, you will naturally skip over the first part of coverage and begin directly in the Initial Coverage Phase.
Our PDP-Planner tool or Donut Hole Calculator uses the annual Centers for Medicare and Medicaid Services (CMS) defined standard Medicare Part D prescription drug plan benefit
parameters (assuming a 25% co-insurance as cost-sharing during the Initial Coverage Phase), the annual Donut Hole discount, and even calculates your "straddle claims" -- drug purchases that cross over more than one drug plan coverage phase. The results of the Donut Hole Calculator can be sent directly to your email account, printed, or viewed online.
We even have older versions of our Donut Hole calculators online in our "Plan Archives" section if you wanted to see how your estimated Medicare Part D spending might have changed over the years.
How about an example?
To get started, we have several Donut Hole or Coverage Gap examples online. You can click here for an example of a Medicare beneficiary with relatively high monthly prescription drug costs (retail drug costs averaging $800 per month), an initial deductible of $435 (the standard 2020 deductible), and we chose to have all of the $800 drug costs are for brand-name formulary medications (0% Generic / 100% Brand).
Right under the example, you can see that this Medicare beneficiary can anticipate entering the Donut Hole or Coverage Gap in June 2020
when their Initial Coverage Limit of $4,020
With monthly retail drug costs of $800, this same person can expect to exit the 2020 Donut Hole some time in December 2020 and enter the Catastrophic Coverage phase
when their True or total out-of-pocket costs
) exceeds $6,350.
In our example, this person’s total annual out-of-pocket drug expenses would be approximately $2,666.
Again, we are assuming coverage began in January - and the Medicare Part D plan included the standard 25% co-insurance rate during the person's Initial Coverage Phase - and 100% of the brand drugs purchased in the Donut Hole received the 75% Donut Hole discount - with 95% of the retail drug costs during the Donut Hole applying to TrOOP.
As a summary, an overview chart shows how this person's drug costs change month-to-month based on the phases or parts of their Medicare Part D plan coverage.
If you wish, you can change the $800 value in our example
to your own prescription spending - change the deductible (which is set at $0 by default) - and choose your mix of generic or brand-name drugs to see a preview of your own Medicare Part D drug coverage.
Still not sure what all these numbers mean to you or need a little extra help?
No problem, click here and let us know