Medicare Part D Coverage Gap Calculator
Calculate costs through deductible, initial coverage, and catastrophic phases.
Coverage Phase Status
Total Drug Costs:$ 8000
In Gap:Yes
Past Gap:No
2024: Gap mostly closed - you pay 25% for both brands and generics.
Phase 1: Deductible
Deductible:$ 505
Your Cost:$ 505
You pay 100% of drug costs until deductible is met. Standard deductible: $545 (2024).
Phase 2: Initial Coverage
Drug Costs:$ 4525
Copay:25%
Your Cost:$ 1131
After deductible, you pay 25% coinsurance. Initial coverage limit: $5,330 total drug costs (2024).
Phase 3: Coverage Gap (Donut Hole)
Drug Costs:$ 2970
Your Share:25%
Your Cost:$ 743
Manufacturer Discount:$ 2079 (brands)
Savings:$ 1485
2024: Gap closed - you pay 25% (brands and generics). Manufacturer pays 70% discount for brands.
Phase 4: Catastrophic Coverage
Threshold:$ 8350
Your Share:5%
Your Cost:$ 0
Copay (Brand):$ 4.50/drug
Copay (Generic):$ 0.10/drug
After $8,400 true out-of-pocket, you pay 5% or small copays. Catastrophic threshold for 2024.
Total Out-of-Pocket
TrOOP (True Out-of-Pocket):$ 2379
Total Drug Costs:$ 8000
TrOOP counts toward catastrophic threshold. Includes deductible, copays, gap costs.
Coverage Gap Key Points
- 2024: Coverage gap mostly closed (you pay 25%)
- Deductible: up to $545 (plan may have lower)
- Initial coverage: 25% coinsurance
- Gap: 25% for brands and generics
- Catastrophic: 5% after $8,400 TrOOP
- Manufacturer pays 70% discount for brands in gap
- TrOOP tracks your true costs
- Extra Help: lower or no copays
- Some plans have no deductible
- Check plan details for exact costs