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2014 PDP-Planner:
Medicare Part D Doughnut Hole Calculator

Try one of our examples or your own scenerio ->
Example 1 illustrates how the Doughnut Hole (Coverage Gap) works when the beneficiary only has monthly prescripiton (Rx) costs. Example 2 showns that if the same monthly costs are paid on a quarterly basis, the total retail costs do not change, however, when one enters and leaves the Coverage Gap does changes. Example 3 shows an example of how to enter you medication costs if they are not consistent.
Examples
1. Monthy Rx Costs only
2. Quarterly Rx Costs only
3. Combination of Rx Costs
Your Own Rx Cost Scenerio
OR Enter Your Average Prescription Drug Costs:*
This is the actual retail cost of your covered prescriptions.
Do not include non-covered prescriptions or non-prescription medications (ex: asprin or over-the-counter vitamins).

We will add all of these costs together to determine your total annual retail prescription costs. Since we do not know when you are making these non-regular purchases, we will place these payments starting in month 1. You can find these values on your regular Medicare Part D plan statements or if you already know the annual costs, just enter the value in the annual costs field.
Paid Monthly:
Paid Quarterly:
Paid Semi-Annually:
Paid Annually:
Enter Your Plans Deductible:
If your plan has a deductible, please enter it here.
The 2014 standard deductible is $310.
The month inwhich your plan started usually January:*
Most plans start in January. If you are just turning 65 or a Medicaid recipient, your plan may start in a month other than January.
Enter your monthly premium, to have it calculated into the total:
 
2014 Doughnut Hole Calculation Summary:
You will enter the Coverage Gap (Doughnut Hole): in April
You will exit the Coverage Gap (Doughnut Hole): with start of new plan year
Your total annual Out-of-Pocket Costs without premium: $3,937.50


2014 Doughnut Hole Calculation Details

Month

Plan Phase
Who Pays Total
Retail

Explanation
You Plan Gov
$$1: JanInitial Coverage $643.75 $1,931.25 $0.00 $2,575.00 You are in the Initial Coverage Phase. Your costs so far $643.75.
$$2: FebInitial Coverage $25.00 $75.00 $0.00 $2,675.00 You are in the Initial Coverage Phase. Your costs so far $668.75.
$$3: MarInitial Coverage $25.00 $75.00 $0.00 $2,775.00 You are in the Initial Coverage Phase. Your costs so far $693.75.
$$4: AprInitial Coverage $18.75 $56.25 $0.00 $2,850.00 You are in the Initial Coverage Phase. Your costs so far $712.50.
$$ Doughnut Hole $425.00 $0.00 $0.00 $3,275.00 You entered the Coverage Gap (Doughnut Hole) in April. Your costs so far excluding the 2014 Coverage Gap Discount are $1,137.50. For plan year 2014, Non-LIS Medicare Beneficiaries get a 21% discount on generics and a 52.5% discount on brand-name drugs purchased in the Coverage Gap. See Examples below for your spending. Read Q&A about the Discount...
$$5: MayDoughnut Hole $100.00 $0.00 $0.00 $3,375.00 You are still in the Doughnut Hole. Your costs so far excluding the 2014 Coverage Gap Discount are $1,237.50 .
$$6: JunDoughnut Hole $100.00 $0.00 $0.00 $3,475.00 You are still in the Doughnut Hole. Your costs so far excluding the 2014 Coverage Gap Discount are $1,337.50 .
$$7: JulDoughnut Hole $1,700.00 $0.00 $0.00 $5,175.00 You are still in the Doughnut Hole. Your costs so far excluding the 2014 Coverage Gap Discount are $3,037.50 .
$$8: AugDoughnut Hole $100.00 $0.00 $0.00 $5,275.00 You are still in the Doughnut Hole. Your costs so far excluding the 2014 Coverage Gap Discount are $3,137.50 .
$$9: SepDoughnut Hole $100.00 $0.00 $0.00 $5,375.00 You are still in the Doughnut Hole. Your costs so far excluding the 2014 Coverage Gap Discount are $3,237.50 .
$$10: OctDoughnut Hole $500.00 $0.00 $0.00 $5,875.00 You are still in the Doughnut Hole. Your costs so far excluding the 2014 Coverage Gap Discount are $3,737.50 .
$$11: NovDoughnut Hole $100.00 $0.00 $0.00 $5,975.00 You are still in the Doughnut Hole. Your costs so far excluding the 2014 Coverage Gap Discount are $3,837.50 .
$$12: DecDoughnut Hole $100.00 $0.00 $0.00 $6,075.00 You are still in the Doughnut Hole. Your costs so far excluding the 2014 Coverage Gap Discount are $3,937.50 .
Summary Who Pays Total
Retail

Explanation
You Plan Gov
Totals without premium: $3,937.50 $2,137.50 $0.00 $6,075.00 Total does not reflect Donut Hole Discount. See Examples below for your spending. Read Q&A about the Discount...
2014 Donut Hole Discount Examples
To give you an idea of the discount you can expect in 2014, 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 $3,260.25$2,814.75$0.00$6,075.00 only generics - you would save $677.25
Totals without premium $3,006.28$2,645.44$0.00$6,075.00 75% generic / 25% brand - you would save $931.22
Totals without premium $2,752.31$2,476.13$0.00$6,075.00 50% generic / 50% brand - you would save $1,185.19
Totals without premium $2,498.34$2,306.81$0.00$6,075.00 25% generic / 75% brand - you would save $1,439.16
Totals without premium $2,244.38$2,137.50$0.00$6,075.00 only brands - you would save $1,693.13
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 2014, 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 $2.55 for generics or $6.35 for brand drugs (which ever is higher).


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Calculators Available:

Doughnut Hole Calculators:
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This Q1Medicare.com Doughnut Hole calculator is based on the 2014 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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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.


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