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2013 PDP-Planner:
Medicare Part D Doughnut Hole Calculator
| 2013 Doughnut Hole Calculation Summary: |
|
| You will enter the Coverage Gap (Doughnut Hole): |
in April |
| You will exit the Coverage Gap (Doughnut Hole): |
in July |
| Your total annual Out-of-Pocket Costs without premium: |
$4,881.13
|
| 2013 Doughnut Hole Calculation Details |
| |
Month |
Plan Phase |
Who Pays |
Total
Retail |
Explanation |
| You |
Plan |
Gov |
| $$ | 1: Jan | Initial Coverage |
$600.00 |
$1,800.00 |
$0.00 |
$2,400.00 |
You are in the Initial Coverage Phase. Your costs so far $600.00. |
| $$ | 2: Feb | Initial Coverage |
$0.00 |
$0.00 |
$0.00 |
$2,400.00 |
You are in the Initial Coverage Phase. Your costs so far $600.00. |
| $$ | 3: Mar | Initial Coverage |
$0.00 |
$0.00 |
$0.00 |
$2,400.00 |
You are in the Initial Coverage Phase. Your costs so far $600.00. |
| $$ | 4: Apr | Initial Coverage |
$142.50 |
$427.50 |
$0.00 |
$2,970.00 |
You are in the Initial Coverage Phase. Your costs so far $742.50. |
| $$ | | Doughnut Hole |
$1,830.00 |
$0.00 |
$0.00 |
$4,800.00 |
You entered the Coverage Gap (Doughnut Hole) in April. Your costs so far excluding the 2013 Coverage Gap Discount are $2,572.50. For plan year 2013, Non-LIS Medicare Beneficiaries get a 21% discount on generics and a 52.5% discount on brand-name drugs purchased in the Coverage Gap. See Examples below for your spending. Read Q&A about the Discount... |
| $$ | 5: May | Doughnut Hole |
$0.00 |
$0.00 |
$0.00 |
$4,800.00 |
You are still in the Doughnut Hole. Your costs so far excluding the 2013 Coverage Gap Discount are $2,572.50 . |
| $$ | 6: Jun | Doughnut Hole |
$0.00 |
$0.00 |
$0.00 |
$4,800.00 |
You are still in the Doughnut Hole. Your costs so far excluding the 2013 Coverage Gap Discount are $2,572.50 . |
| $$ | 7: Jul | Doughnut Hole |
$2,177.50 |
$0.00 |
$0.00 |
$6,977.50 |
You are still in the Doughnut Hole. Your costs so far excluding the 2013 Coverage Gap Discount are $4,750.00 . |
| $ | | Catastrophic Coverage |
$11.13 |
$33.38 |
$178.00 |
$7,200.00 |
You exited the Coverage Gap (Doughnut Hole) in July and are now in the catastrphic coverage. We have used 5% to calculate your costs. The actual calculation is $2.65 for generics, $6.6 for brands or 5% which ever is higher. Your costs so far $4,761.13. |
| $ | 8: Aug | Catastrophic Coverage |
$0.00 |
$0.00 |
$0.00 |
$7,200.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $4,761.13. |
| $ | 9: Sep | Catastrophic Coverage |
$0.00 |
$0.00 |
$0.00 |
$7,200.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $4,761.13. |
| $ | 10: Oct | Catastrophic Coverage |
$120.00 |
$360.00 |
$1,920.00 |
$9,600.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $4,881.13. |
| $ | 11: Nov | Catastrophic Coverage |
$0.00 |
$0.00 |
$0.00 |
$9,600.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $4,881.13. |
| $ | 12: Dec | Catastrophic Coverage |
$0.00 |
$0.00 |
$0.00 |
$9,600.00 |
You will remain in Catastrophic Coverage until the end of the year. Your costs so far $4,881.13. |
| Summary |
Who Pays |
Total
Retail |
Explanation |
| You |
Plan |
Gov |
| Totals without premium: |
$4,881.13 |
$2,620.88 |
$2,098.00 |
$9,600.00 |
Total does not reflect Donut Hole Discount. See Examples below for your spending. Read Q&A about the Discount... |
| 2013 Donut Hole Discount Examples |
| To give you an idea of the discount you can expect in 2013, below are examples of changes in total out of pocket costs when varying the types of drugs purchased in the Donut Hole. The examples are calculated based on the percentage of drugs purchased in the Coverage Gap that are generics vs. brands. The savings noted below are appoximate (discount not applied to the dispencing fee). |
| Summary |
Who Pays |
Total
Retail |
Explanation |
| You |
Plan |
Gov |
| Totals without premium |
$4,039.55 | $3,462.45 | $2,098.00 | $9,600.00 |
only generics - you would save $841.57 |
| Totals without premium |
$3,723.96 | $3,252.06 | $2,098.00 | $9,600.00 |
75% generic / 25% brand - you would save $1,157.17 |
| Totals without premium |
$3,408.37 | $3,041.66 | $2,098.00 | $9,600.00 |
50% generic / 50% brand - you would save $1,472.76 |
| Totals without premium |
$3,092.78 | $2,831.27 | $2,098.00 | $9,600.00 |
25% generic / 75% brand - you would save $1,788.35 |
| Totals without premium |
$2,777.19 | $2,620.88 | $2,098.00 | $9,600.00 |
only brands - you would save $2,103.94 |
Notes:
* Co-payments do not influence when you will enter and leave the Doughnut Hole (which is based on plan’s negotiated retail drug costs). It will only affect your out-of-pocket costs.
** For plan years 2011 and on, The discount on brand-name drugs purchased in the Coverage Gap (or Donut Hole) does not influence when you exit the Coverage Gap. |
| Legend: |
| $$$ |
You are responsible for 100% of your prescription (Rx) costs. This occurs during the Initial Deductible Phase of coverage. (Many plans do not have an initial deductible.) It also occured in the Coverage Gap (Doughnut Hole) unless your plan has Doughnut Hole coverage. |
| $$ |
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 co-payment on enhanced plans.
In plan year 2013, your drug costs are also shared during the Coverage Gap. The plan pays 21% of your generic drug costs and the drug manufacturer pays 52.5% of your brand drug costs. Read Q&A about the Discount... |
| $ |
You pay a small fraction of your prescription (Rx) costs. This occurs in Catastrophic Coverage. You pay 5% of your medication costs or $2.65 for generics or $6.6 for brand drugs (which ever is higher).
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Calculators Available:
Plan Out-of-Pocket Cost Calculators:
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Doughnut Hole Calculators:
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This Q1Medicare.com Doughnut Hole calculator is based on the 2013 CMS Standard Benefit Medicare Part D plan and designed to estimate when a Medicare Part D beneficiary would (1) enter and exit the coverage gap and (2) the potential prescription costs for the year. The actual time when a Medicare Part D beneficiary enters the Doughnut Hole and the costs associated with the plan may vary depending on the chosen Medicare Part D plan.
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