All of the out-of-pocket drug cost the consumer pays goes toward pushing them through the coverage gap and potentially into the catastrophic phase. These costs would include any deductible, copayments and coinsurance of the initial coverage phase, and the 25 percent coinsurance in the coverage gap. However, in the coverage gap, the consumer’s accumulated dollar amount is credited with the drug manufacturers 70 percent discount on brand name drugs.
The great thing about Medicare is that you can build your train the way you want. You can change the train cars every year. But the important aspect is that you own the Medicare engine. You are the engineer and you can build your train the way you want it.
I have created a spreadsheet that is fairly simple to pop in premiums, monthly drug copay and any deductible to determine a yearly estimated cost of the plan. Perhaps the most daunting aspect is collecting the data. Each plan publishes a drug formulary that will list if the drug is covered, the tier, copay for each tier and any deductible.