2010 Donut Hole Calculation Summary: | |
Summary of the annual retail cost of your drugs:
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Percentage of Generic vs. Brand drug purchases used: | |
No factor 100% Responsible in Gap | |
You will enter the Coverage Gap (Donut Hole): | in April |
You will exit the Coverage Gap (Donut Hole): | in September |
Your total annual Out-of-Pocket Costs without premium: | $4,708.00 |
Your total annual Out-of-Pocket Costs without premium and with the 2010 $250 Rebate for persons not receiving "Extra Help" Read More... |
$4,458.00 |
2010 Donut Hole Calculation Details | |||||||
Month |
Plan Phase |
Who Pays | Total Retail |
||||
You | Plan | Mfgr | Gov | ||||
$$$ | 1: Jan | Deductible | $310.00 | $0.00 | $0.00 | $0.00 | $310.00 |
Your deductible is less than your Rx costs for the month, so here we will use the deductible of $310 and on the next line you will see your initial coverage costs for the remainder of this month. Your costs so far $310. | |||||||
$$ | 1: Jan | Initial Coverage | $122.50 | $367.50 | $0.00 | $0.00 | $800.00 |
You satisfied the remainder of your deductible ($310) earlier this month. Now, in the Initial Coverage phase, you pay 25% of the remaining Rx costs for the month ($490.00) (upto the initial coverage limit--ICL) and your plan pays 75%. Some plan offer copayments instead.* Your costs so far $432.50. | |||||||
$$ | 2: Feb | Initial Coverage | $200.00 | $600.00 | $0.00 | $0.00 | $1,600.00 |
You are in the Initial Coverage Phase. Your costs so far $632.50. | |||||||
$$ | 3: Mar | Initial Coverage | $200.00 | $600.00 | $0.00 | $0.00 | $2,400.00 |
You are in the Initial Coverage Phase. Your costs so far $832.50. | |||||||
$$ | 4: Apr | Initial Coverage | $107.50 | $322.50 | $0.00 | $0.00 | $2,830.00 |
You are in the Initial Coverage Phase. Your costs so far $940.00. | |||||||
$$$ | 4: Apr | Donut Hole | $370.00 | $0.00 | $0.00 | $0.00 | $3,200.00 |
You entered the Coverage Gap (Donut Hole) in April. Your costs so far $940.00. For plan year 2010 only, Medicare Beneficiaries who are not receiving "Extra Help" and reach the Coverage Gap will receive a $250 rebate. Read More... | |||||||
$$$ | 5: May | Donut Hole | $800.00 | $0.00 | $0.00 | $0.00 | $4,000.00 |
You are still in the Donut Hole. Your costs so far $940.00. | |||||||
$$$ | 6: Jun | Donut Hole | $800.00 | $0.00 | $0.00 | $0.00 | $4,800.00 |
You are still in the Donut Hole. Your costs so far $940.00. | |||||||
$$$ | 7: Jul | Donut Hole | $800.00 | $0.00 | $0.00 | $0.00 | $5,600.00 |
You are still in the Donut Hole. Your costs so far $940.00. | |||||||
$$$ | 8: Aug | Donut Hole | $800.00 | $0.00 | $0.00 | $0.00 | $6,400.00 |
You are still in the Donut Hole. Your costs so far $940.00. | |||||||
$$$ | 9: Sep | Donut Hole | $40.00 | $0.00 | $0.00 | $0.00 | $6,440.00 |
You are still in the Donut Hole. Your costs so far $940.00. | |||||||
$ | 9: Sep | Catastrophic Coverage | $38.00 | $114.00 | $0.00 | $608.00 | $7,200.00 |
You exited the Coverage Gap (Donut Hole) in September and are now in the catastrophic coverage. We have used 5% to calculate your costs.
The actual calculation is $2.50 for generics, $6.3 for brands or 5% whichever is higher. Your costs so far $4,588.00. | |||||||
$ | 10: Oct | Catastrophic Coverage | $40.00 | $120.00 | $0.00 | $640.00 | $8,000.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $4,628.00. | |||||||
$ | 11: Nov | Catastrophic Coverage | $40.00 | $120.00 | $0.00 | $640.00 | $8,800.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $4,668.00. | |||||||
$ | 12: Dec | Catastrophic Coverage | $40.00 | $120.00 | $0.00 | $640.00 | $9,600.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $4,708.00. | |||||||
Summary |
Who Pays | Total Retail |
|||||
You | Plan | Mfgr | Gov | ||||
Totals without premium: | $4,708.00 | $2,364.00 | $0.00 | $2,528.00 | $9,600.00 | ||
Totals without premium and with rebate: | $4,458.00 | $2,364.00 | $2,528.00 | $9,600.00 | Reflects the $250 rebate** | ||
Notes: *Copayments do not influence when you will enter and leave the Donut Hole (which is based on plan’s negotiated retail drug costs). It will only affect your out-of-pocket costs. ** For plan year 2010 only, Medicare Beneficiaries who are not receiving "Extra Help" and reach the Coverage Gap (Donut Hole) will receive a one-time, tax-free $250 rebate. You can expect to receive your rebate check automatically, approximately 45 days after you reach the Coverage Gap. There is no paperwork to be filled out. Read More... | |||||||
Legend: | |||||||
$$$ | 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. ) | ||||||
$$ | 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. | ||||||
$ | You pay a small fraction of your prescription (Rx) costs. This occurs in Catastrophic Coverage. You pay 5% of your medication costs or $2.50 for generics or $6.3 for brand drugs (whichever is higher). |
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