2013 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: | |
0% Generic / 100% Brand (not vaccine adjusted) | |
You will enter the Coverage Gap (Donut Hole): | in April |
You will exit the Coverage Gap (Donut Hole): | with start of new plan year |
Your total annual Out-of-Pocket Costs without premium: | $2,217.38 |
2013 Donut Hole Calculation Details | |||||||
Month |
Plan Phase |
Who Pays | Total Retail |
||||
You | Plan | Mfgr | Gov | ||||
$$ | 1: Jan | Initial Coverage | $643.75 | $1,931.25 | $0.00 | $0.00 | $2,575.00 |
You are in the Initial Coverage Phase. Your costs so far $643.75. | |||||||
$$ | 2: Feb | Initial Coverage | $25.00 | $75.00 | $0.00 | $0.00 | $2,675.00 |
You are in the Initial Coverage Phase. Your costs so far $668.75. | |||||||
$$ | 3: Mar | Initial Coverage | $25.00 | $75.00 | $0.00 | $0.00 | $2,775.00 |
You are in the Initial Coverage Phase. Your costs so far $693.75. | |||||||
$$ | 4: Apr | Initial Coverage | $48.75 | $146.25 | $0.00 | $0.00 | $2,970.00 |
You are in the Initial Coverage Phase. Your costs so far $742.50. | |||||||
$$ | 4: Apr | Donut Hole | $144.88 | $7.63 | $152.50 | $0.00 | $3,275.00 |
You entered the Coverage Gap (Donut Hole) in April. Your costs so far including the 2013 Coverage Gap Discount are $887.38. Your credit toward exiting the Coverage Gap is $1,039.88. This includes what you spent plus what the brand-name drug manufacturer (Mfgr) spent on your behalf. For plan year 2013, Non-LIS Medicare Beneficiaries get a 21% discount on generics and a 52.5% discount on brand-name drugs purchased in the Coverage Gap. Read Q&A about the Discount... | |||||||
$$ | 5: May | Donut Hole | $47.50 | $2.50 | $50.00 | $0.00 | $3,375.00 |
You are still in the Donut Hole. Your costs so far including the 2013 Coverage Gap Discount are $934.88. Your credit toward exiting the Coverage Gap is $1,137.38. | |||||||
$$ | 6: Jun | Donut Hole | $47.50 | $2.50 | $50.00 | $0.00 | $3,475.00 |
You are still in the Donut Hole. Your costs so far including the 2013 Coverage Gap Discount are $982.38. Your credit toward exiting the Coverage Gap is $1,234.88. | |||||||
$$ | 7: Jul | Donut Hole | $807.50 | $42.50 | $850.00 | $0.00 | $5,175.00 |
You are still in the Donut Hole. Your costs so far including the 2013 Coverage Gap Discount are $1,789.88. Your credit toward exiting the Coverage Gap is $2,892.38. | |||||||
$$ | 8: Aug | Donut Hole | $47.50 | $2.50 | $50.00 | $0.00 | $5,275.00 |
You are still in the Donut Hole. Your costs so far including the 2013 Coverage Gap Discount are $1,837.38. Your credit toward exiting the Coverage Gap is $2,989.88. | |||||||
$$ | 9: Sep | Donut Hole | $47.50 | $2.50 | $50.00 | $0.00 | $5,375.00 |
You are still in the Donut Hole. Your costs so far including the 2013 Coverage Gap Discount are $1,884.88. Your credit toward exiting the Coverage Gap is $3,087.38. | |||||||
$$ | 10: Oct | Donut Hole | $237.50 | $12.50 | $250.00 | $0.00 | $5,875.00 |
You are still in the Donut Hole. Your costs so far including the 2013 Coverage Gap Discount are $2,122.38. Your credit toward exiting the Coverage Gap is $3,574.88. | |||||||
$$ | 11: Nov | Donut Hole | $47.50 | $2.50 | $50.00 | $0.00 | $5,975.00 |
You are still in the Donut Hole. Your costs so far including the 2013 Coverage Gap Discount are $2,169.88. Your credit toward exiting the Coverage Gap is $3,672.38. | |||||||
$$ | 12: Dec | Donut Hole | $47.50 | $2.50 | $50.00 | $0.00 | $6,075.00 |
You are still in the Donut Hole. Your costs so far including the 2013 Coverage Gap Discount are $2,217.38. Your credit toward exiting the Coverage Gap is $3,769.88. | |||||||
Summary |
Who Pays | Total Retail |
|||||
You | Plan | Mfgr | Gov | ||||
Totals without premium: | $2,217.38 | $2,305.13 | $1,552.50 | $0.00 | $6,075.00 | ||
Notes: *Copayments do not influence when you will enter and leave the Donut Hole (which is based on plan’s negotiated retail drug costs). It will only affect your out-of-pocket costs. **For plan years 2011 to 2024, the chart values include the Donut Hole Discount. Read Q&A about the Discount. ***Beginning with plan year 2024, the Inflation Reduction Act (IRA) of 2022 eliminates beneficiary cost-sharing once your TrOOP reaches the established maximum cap on out-of-pocket spending for Part D formulary drugs (RxMOOP). | |||||||
Legend: | |||||||
$$$ | 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 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... |
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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 $2.65 for generics or $6.6 for brand drugs (whichever is higher). |
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