My pharmacist mentioned the Medicare "donut hole" is going away in 2025. What does that actually mean for me?
Answered by 23 licensed agents
Now that 2025 has arrived, with the elimination of the "donut hole", the most anyone will be spending for either their cumulative generic or the brand name drugs they're prescribed is a maximum of $2,000.00. This is tracked by Medicare and the approx. $6K savings is going to be a boon to those without secure finances.
Answered by Steven Bleicher on April 24, 2025
Broker Licensed in AZ
Answered by Melonie Wood on April 4, 2025
Agent Licensed in FL & AL
Answered by Ben Washington on April 8, 2025
Broker Licensed in IL, FL, MN, SC, TX & WI
Answered by Alondra Arce on April 14, 2025
Agent Licensed in CA, AL, AR & 14 other states
Answered by Alison Hummel on May 13, 2025
Agent Licensed in NJ & PA
Answered by Amy Twary on April 15, 2025
Broker Licensed in NC, OH, SC & TN
Answered by Timothy Brown on April 8, 2025
Broker Licensed in PA, CT, DE & 15 other states
Answered by Yasmery Vargas on April 15, 2025
Agent Licensed in PA
Answered by Deb Haley on April 17, 2025
Broker Licensed in MA, CT, FL & 10 other states
Answered by Chad Watkins on May 14, 2025
Agent Licensed in NJ, AK, AL & 48 other states
Your yearly out of pocket prescription costs are capped at $2,000.
Answered by Denise Berg on April 4, 2025
Broker Licensed in CO, AL, AZ & 15 other states
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.
Answered by Matt Vinez on April 21, 2025
Broker Licensed in MN, FL, IA & OH, SD, TX & WI
Answered by Steve Brauer on April 8, 2025
Broker Licensed in AZ & CA
Here's a more detailed breakdown:
What was the "donut hole"?
It was the coverage gap in Medicare Part D, where you had to pay a higher percentage of your prescription costs after your plan had paid a certain amount towards your medication. This could lead to unpredictable and potentially high out-of-pocket expenses.
What's the new out-of-pocket cap?
In 2025, your annual out-of-pocket costs for covered prescription drugs will be capped at $2,000.
What happens after you reach the $2,000 cap?
Once you reach that limit, your costs for covered prescriptions will be $0 for the rest of the year. This means you won't have to pay any copayments or coinsurance for covered drugs.
How will this affect me?
This change should make your prescription drug costs more predictable and manageable, especially if you have chronic conditions and need ongoing medications.
What about other changes to Medicare in 2025?
Besides the elimination of the donut hole, there are also changes to Medicare Part A and Part B premiums and cost-sharing, and adjustments to income-related premium surcharges.
In essence, the elimination of the donut hole and the implementation of the out-of-pocket spending cap aim to simplify Medicare Part D coverage and make it more affordable for beneficiaries like you.
Answered by Fred Manas on May 6, 2025
Agent Licensed in NY, CT, DC & 7 other states
Answered by Jerry Cohen on April 21, 2025
Broker Licensed in NY
1. Deductible Stage - you are responsible for 100% of your prescription drug costs until the deductible is hit. Plans can have a deductible of NO MORE THAN $590 in 2025. Some plans will have a smaller deductible or no deductible at all.
2. Initial Coverage Stage - you pay up to a 25% coinsurance for medication on your plan's formulary or list of covered medications. The most you will spend is $2,000 out of pocket. Some plan will have very low or no copays on prescriptions in varying tiers within their formulary or list of covered medications.
3. Catastrophic Coverage Stage - once you hit the $2,000 out of pocket cap, you won't have any more out of pocket costs. All medications on the formulary will be covered at 100%.
4. Annual Reset - regardless of when your coverage began, all Medicare Part D plans (including those that come with a Medicare Advantage Plan) return to the Deductible Stage on January 1st of each year.
Please be aware that if you change your plan during the year, you do not start the stages over on the new plan. This information follows you through your Medicare journey.
Answered by David Christian on April 18, 2025
Broker Licensed in CA & TX
It is a great reduction in Rx.
Answered by Rachael Metcalf on April 17, 2025
Agent Licensed in TN, FL, GA & 5 other states
Answered by Jack Mayer on April 14, 2025
Agent Licensed in CA & NV
Answered by Sean Krause on April 22, 2025
Broker Licensed in TN
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
Answered by Lowell Ryals on April 3, 2025
Broker Licensed in MO, AR, FL, KS, LA & TX
Answered by Aaron Young on April 8, 2025
Agent Licensed in OK, AR, GA & 6 other states
Answered by Eva Peterson on April 21, 2025
Agent Licensed in CA, FL & NV
Answered by Tommy Lawson on April 8, 2025
Broker Licensed in KY, CT & IN
Tags: Medicare Part D Prescription Drug
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