My pharmacist mentioned the Medicare "donut hole" is going away in 2025. What does that actually mean for me?

Question

Melonie Wood · Accepted Answer

The "donut hole" (or coverage gap) in Medicare Part D prescription drug coverage is being eliminated in 2025, meaning once your out-of-pocket costs reach $2,000, you won't pay anything for covered medications for the rest of the year.

Answered by Melonie Wood on April 4, 2025

Agent Licensed in FL & AL

Answered by Melonie Wood Medicare Insurance Agent

Yasmery Vargas · Answer

The maximum out of pocket for prescription was reduced to $2000 a year. Once the $2000 has been met between you and your insurance company, your prescriptions would be covered. It will reset every year.

Answered by Yasmery Vargas on April 15, 2025

Agent Licensed in PA

Answered by Yasmery Vargas Medicare Insurance Agent

Matt Vinez · Answer

For those who have high priced meds, and typically have high expenses, your coverage got significantly better. Your max RX spend each year will be $2000, assuming everything is on your plan's formulary.
For those with low to mid RX spends, your coverage likely is getting worse. You'll frequently see higher copays, RX deductibles, and higher co-insurance levels. This will cause more of you to hit the $2000 max as well.
Finally, in an effort to contain costs, some carriers opted to move to a direct sale method, rather than selling through local brokers, which could cause a decline in qualify for customer service.

Rachael Metcalf · Answer

That means you are going to only be put of pocket $2000 before your drugs are at no cost.
It is a great reduction in Rx.

Jerry Cohen · Answer

Eklimination of the donut whole means that a big portion of patient cost sharing on prescription medication expenses has been eliminated. In 2025 maximum out of pockets expense for a covered person becomes $ 2,000.

Answered by Jerry Cohen on April 21, 2025

Broker Licensed in NY

Answered by Jerry Cohen Medicare Insurance Agent

Lowell Ryals · Answer

It
Means that your prices won’t go up through the year 
You may have a deductible with your prescriptions
You can also apply for a leveling out program to keep your copays level through the year

Aaron Young · Answer

What this means is that you will likely spend less on your medications than you have in past years.  For 2025 and beyond, the prescription drug plans will have a max out of pocket of $2000.

Tommy Lawson · Answer

It means there is no longer a coverage gap that you are 100% responsible for paying. As long as your medications are covered on a carriers formulary, no matter how expensive the copay or retail cost may be, you have a maximum out of pocket on prescriptions of $2000 for the year.

Answered by Tommy Lawson on April 8, 2025

Broker Licensed in KY, CT & IN

Answered by Tommy Lawson Medicare Insurance Agent

My pharmacist mentioned the Medicare "donut hole" is going away in 2025. What does that actually mean for me?

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My pharmacist mentioned the Medicare "donut hole" is going away in 2025. What does that actually mean for me?

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A non-government resource website