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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 - $12 to $192 Paid by the Medicare Beneficiary (See our Medicare Part D Plan Overview by State to review features and premiums of plans available in your state.)
Annual Deductible - $435 Paid by the Medicare Beneficiary
Cost of Prescriptions ($436 - $4020) -
25% Paid by the Medicare Beneficiary - 75% Paid by Medicare
Cost of Prescriptions ($4021 - $9038.75) -
100 % Paid by the Medicare Beneficiary - 0% Paid by Medicare
More than $6350 annual out-of-pocket threshold - The Medicare Beneficiary pays the greater of either 5% of the prescription drug costs or $3.60; ?> for generic prescription drugs and $8.95 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.

Just click on the link below to calculate an estimate of your out-of-pocket expenditures with Medicare Part D.

Here is an example of how the 2020 out-of-pocket costs add-up.

If a Medicare beneficiary had prescription drug costs of $9038.75 per year, here is how much it would cost the Medicare Part D beneficiary personally or out-of-pocket:
Annual Deductible (or first $435 spent):-$435
25% of ($4020 - $435 = $3585):-$896.25
100% of ($9038.75 - $4020 = $5018.75):-$5018.75
Total Cost to Medicare Beneficiary (out-of-pocket):-$6350

Therefore, our Medicare beneficiary that had Prescription drug costs of $9038.75, would have approximately $6350 of out of pocket or personal costs per year.


What if our example Medicare beneficiary has Prescription drug costs of more than $9038.75?

Once our example Medicare Beneficiary has spent approximately $6350, the last paragraph of the guidelines goes into effect:

More than $6350 annual out-of-pocket threshold
  • The Medicare Beneficiary pays: the greater of either: (1) 5% of the Prescription Drug Costs or (2) $3.60 for generic Prescription Drugs / $8.95 for brand-name Prescription Drugs.
  • Medicare Pays: the lesser of either: (1) 95% of the Prescription Drug costs or (2) the balance of the Prescription Drug costs.
At this point in our example, the costs to the Medicare beneficiary will depend on the type/cost of prescription medication that is purchased. For example, if the Medicare beneficiary purchases non-generic Prescription drugs costing more than $8.95, the Medicare Beneficiary would need to pay 5% of the total costs.