| Coverage Gap, the "Doughnut Hole" |
If your Medicare Part D plan has a coverage gap, or "doughnut hole", you will pay full retail price for prescriptions
in that gap. For example, many plans have good coverage for the first $2,500, then no coverage at all
between $2,500 and $5,000, then excellent coverage beyond that. If your estimated total prescription
expenses for the year will be between $3,500 and $5,500, you would do better to buy the low-cost
medicine from Canada once you reach that gap at $2,500. Here's how some plans work: you get 75% coverage
for the first $2,500, with an initial membership fee of $250, and a monthly fee of $30.
| Calculation Assumptions |
| Your Yearly Drug Costs |
$5,000.00 |
| Initial Membership |
$250.00 |
| Monthly Premiums |
$20.00 |
| Coverage Below $2,500/year |
75% |
After the first $2,500 of prescriptions, (ie 6 Months) you have spent 25% of $2,500 ($625), plus your initial membership fee of $250,
plus 6 months of premiums at $20 ($120). You have spent $995 for $2,500
worth of medicine, which is 39.9%, and Medicare has covered the remaining 60.1%.
| First 6 Months, $2,500 worth of Drugs |
| Out of Pocket |
Value of Drugs |
You Paid (%) |
Medicare Paid (%) |
| $995 |
$2,500 |
39.9% |
60.1% |
Now, the next $2,500 comes directly out of your pocket, so over the next six months, you will have another
6 months of monthly premiums, plus $2,500 of actual expenses, so you've spent another $2,620. Over the entire
year, you have spent $995 + $2,620 = $3,615, and received $5,000 dollars of value, so your spending
percentage is 72.3%, and Medicare has covered the remaining 27.7%.
First YEAR, $5,000 worth of Drugs, Your Plan Only |
| Out of Pocket |
Value of Drugs |
You Paid (%) |
Medicare Paid (%) |
| $3,615 |
$5,000 |
72.3% |
27.7% |
If, on the other hand, the medications for the second half of the year are purchased from Meds Via Canada,
at an average estimated savings of only 30%, your expenditures in the second half of the year would only be
70% of $2,500, or $1,750. You would still be paying your monthly premiums of $20 over 6 months ($120),
for an out of pocket total of $1,870. Your yearly total is now $995 + $1,870 = $2,865. You have
spent $2,865 and received $5,000 of drugs, for a spending percentage of only 57.3%, and an actual savings
of ($3,615 - $2,865) $750 dollars. Medicare has now covered 42.8%.
First YEAR, $5,000 worth of Drugs, Using Meds Via Canada |
| Out of Pocket |
Value of Drugs |
You Paid (%) |
Medicare Paid (%) |
| $2,865 |
$5,000 |
57.3% |
42.8% |
| You have saved $750.00 |
In fact, if your drug costs during the year are up to about $5,800 in total, you would do better
to purchase the second half of your drugs from Meds Via Canada.
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This example uses an estimated overall savings of 30% by ordering your medications from Canada, after
your reach the first coverage limit of $2,500. It assumes a yearly membership of $250, mothly premiums of
$20, and a co-pay of $0. Your actual savings may vary depending on the medications
you take, and the membership and premium amounts that you pay.
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