Medicare Prescription Drug Benefit Calculator

This calculator allows you to estimate out-of-pocket spending under the new prescription drug benefit.

Who should use this calculator?

Use the calculator if you ...

are enrolled in the new Medicare prescription drug plans and
have no other insurance to cover your drug costs. (This means you pay 100 percent of your drug costs right now.)

Who should not use this calculator?

Do not use the calculator if you ...

qualify for low income special assistance: an income less than $14,450 (single) or less than $19,500 (couples) — or 150 percent of the projected 2006 federal poverty level qualify for this assistance. For this, you will need to apply for separate funding.
are retired with health coverage or individual health insurance.

Enter annual drug costs below (please do not use the dollar sign when entering number) and click on “calculate.”

Beneficiary out-of-pocket costs:
Beneficiary out-of pocket costs under the new benefit	Beneficiary costs including estimated average premium of $420 per year	Share of drug expenses paid out of pocket by beneficiary under the new benefit (not including premium)

Description of the new prescription drug benefit

Signed into law on Dec. 8, 2003, the Medicare Prescription Drug, Improvement and Modernization Act will begin providing prescription drug assistance for people on Medicare on Jan. 1, 2006. Beneficiaries can determine their out-of-pocket drug expenses under the new Medicare Part D.

Summary of the plan (per person or couple?)*:

The plan is voluntary (your choice).
The initial premium is $35 per month ($420 per year).
The plan has a $250 deductible.
You will pay 25 percent of any drug costs $251 up to $2,250 and Medicare will pay the remaining 75 percent.
You will pay costs from $2,250 to $5,100 and Medicare pays nothing.
You will pay 5 percent of any drug costs more than $5,100 and Medicare will pay the remaining 95 percent.

*This plan is subject to future increases.

Sources:

Henry J. Kaiser Family Foundation
Centers for Medicaid and Medicare Services

First published: 5/5/2005
Last updated: 5/6/2005
Reviewed by: Pat Oberembt, director of pharmacy, Allina Community Pharmacies

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