Calculate your Out-Of-Pocket Expenditure!

Medicare set the following guidelines for Medicare Part D prescription drug plans, however, available plans may vary from these guidelines.

Monthly Premium - $35.00 to $37.00 Paid by the Medicare Beneficiary (actual premium not yet announced)
Annual Deductible - $250.00 Paid by the Medicare Beneficiary
Cost of Prescriptions ($251 - $2,250) -
25% Paid by the Medicare Beneficiary - 75% Paid by Medicare
Cost of Prescriptions ($2,251 - $5,100) -
100 % Paid by the Medicare Beneficiary - 0% Paid by Medicare
More than $3,600 annual out-of-pocket threshold - The Medicare Beneficiary pays the greater of either 5% of the prescription drug costs or $2 for generic prescription drugs and $5 for brand-name prescription drugs. Medicare Part D pays the lesser of either: 95% of the prescription drug costs or the balance of the prescription drug costs.

Here is an example of how the out-of-pocket costs add-up.


If a Medicare beneficiary had prescription drug costs of $5,100 per year, here is how much it would cost the Medicare Part D beneficiary personally or out-of-pocket:

Annual Deductible (or first $250 spent):	-	$250
25% of ($2,250 - $250 = $2000):	-	$500
100% of ($5,100 - $2,250 = $2,850):	-	$2,850
Total Cost to Medicare Beneficiary (out-of-pocket):	-	$3,600

Therefore, our Medicare beneficiary that had Prescription drug costs of $5,100, would have approximately $3,600 of out of pocket or personal costs per year.

What if our example Medicare beneficiary has Prescription drug costs of more than $5,100?

Once our example Medicare Beneficiary has spent approximately $3,600, the last paragraph of the guidelines goes into effect:

More than $3,600 annual out-of-pocket threshold