I've been dreading hitting the donut hole each year. How will its elimination in 2025 change what I pay throughout the year?

Question

Timothy Brown · Accepted Answer

The Inflation Reduction Act of 2025 has reduced the out-of-pocket maximum for prescription drug coverage to $2,000. There will be no additional cost beyond this point, meaning the copay for any and all medications for the remainder of the year will be $0 after the $2 000 limit has been reached. As it's been in the past, low cost generic prescriptions are typically not a concern but as it relates to brand name prescriptions, here's some is some useful information: 

1. Depending on the plan, you may now incur a coinsurance instead of a flat copay

2. Some Medicare Advantage plans may now have a Part Deductible for various tiers

Melonie Wood · Answer

With all the 2025 Medicare Plans & Prescription Drug Plans, once a person reaches $2000 in cost including 25% of the drugs cost towards the $2000, there is no more costs to the member, therefore, no more "donut hole"

Answered by Melonie Wood on April 4, 2025

Agent Licensed in FL & AL

Answered by Melonie Wood Medicare Insurance Agent

Andrew Zurbuch, MBA · Answer

With the $2,000 maximum  in place in 2025 it should drastically lower your out of pocket prescription costs for prescriptions covered under Medicare Part D. You can also use a Mail Order pharmacy to lower your prescription costs if your prescriptions are available on Mail Order.
Please see www.locatemedicareinsurance.com for other information.

Andrew J. Zurbuch, MBA

Licensed Broker

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Bill Wheeler · Answer

As of 2025 the donut hole is no longer in effect. Your prescription cost will continue till you reach $2000.00. After that you go to zero copay.

Robert Pennington · Answer

The maximum a senior will pay out of pocket for Rx in 2025 will be $2000.  This can be
Setup on a 12 month payment plan and be deducted from your SS each month. When you order or pick up Rx through the year, you pay $0.

James Carlson · Answer

The annual out of pocket limit for all drug purchases is $2,000. The donut hole is not a factor.
The annual deductible applies toward the oop max.

Amy Putrino · Answer

No more "donut hole". As of January 1st, 2025, we all live is a world of donuts without holes! (picture a Boston Cream donut). Your drug coverage goes from January 1st to December 31st with NO coverage gap!

Answered by Amy Putrino on June 9, 2025

Agent Licensed in RI, CT, FL & 11 other states

Answered by Amy Putrino Medicare Insurance Agent

Robert Moore · Answer

Currently there will not be a donut hole going forward.  So what this means for you is after you meet the $2000 max out of pocket you will no longer be paying for your medications.

Lauryn Ivey · Answer

For 2025, if you reach a true out of pocket expense that totals $2,000 then you don’t pay anything else for the rest of the year. This $2,000 includes your copays and any deductible that may apply to your plan. Without knowing your plan and which medications you currently take that is as specific as I can be to your question, because plans vary and the deductible may or may not have to be paid by you depending on the tier drugs you take.

Answered by Lauryn Ivey on July 4, 2025

Broker Licensed in AL

Answered by Lauryn Ivey Medicare Insurance Agent

Ali Crouch · Answer

In 2025, the donut hole disappeared. A cap of $2000 for prescriptions became regulated throughout all drug plans. However, formularies still matter; if the prescription is not in the company's formulary, the person would pay full price for the medication.

Answered by Ali Crouch on June 24, 2025

Broker Licensed in NE, AZ, CO & 9 other states

Answered by Ali Crouch Medicare Insurance Agent

Steven Bleicher · Answer

You've been happy to learn that the donut hole has been abolished. This is a great savings for people who take a variety of different drugs. There is a $2000.00 maximum out-of-pocket through 2027 matter whether you take generic drugs or Brand Name drugs. Last year, folks paid a maximum of $8,050.00 in the donut hole and it has been replaced by the $2,000.00!! Medicare keeps track of your costs for you.

Don't forget that you have options with regard to paying for a copay for a drug. These are as follows: A) Making a copay for a prescription at your "Preferred" or in-network pharmacy when you have an Advantage plan, B) if you opted for a Medicare Supplement, along with a "Stand-Alone" Part D prescription drug plan, again going to a in-network preferred pharmacy can be your best choice, except for C) using an online discount pharmacy (like GoodRx.com, singlecare.com, costplusdrugs.com, etc., which can yield a better price than thru your Part D drug plan. That is an option; but you can only use one or the other for the same drug. Also, remember that if you've had success in the use of a Canadian online discount pharmacy, those out-of-pocket costs will no longer be applied toward that $2K deductible.

Daintee Hurst Dietz · Answer

A thorough review is necessary. Not all plans cover all drugs. With the appropriate plan you’d have a max of $2000 for covered drugs. For those either expensive meds this is going to be a big financial help.

Answered by Daintee Hurst Dietz on June 21, 2025

Agent Licensed in TX

Answered by Daintee Hurst Dietz Medicare Insurance Agent

Hannah Skinner · Answer

The donut hole has been replaced with a maximum out of pocket. For 2025, this Maximum out of pocket is $2000 for the year. This means that as long as your medications are covered under a plan's formulary, you will never pay more than $2000 for those medications in one year. This change has resulted in some plans raising their premiums and changing their formularies.

Answered by Hannah Skinner on July 16, 2025

Agent Licensed in SC, AL, AR & 44 other states

Answered by Hannah Skinner Medicare Insurance Agent

Michael Crocker · Answer

There's no donut hole in 2025; instead, there is a $2000 limit on what you can spend on covered prescription drugs. The "covered" part is extremely important; if you purchase a prescription that isn't covered by your plan, the cost of the drug doesn't apply to the $2000 limit.

Answered by Michael Crocker on April 12, 2025

Broker Licensed in SC

Answered by Michael Crocker Medicare Insurance Agent

Elayne Cotton · Answer

The donut hole is no longer a problem - it's been eliminated!  And the maximum out of pocket for medications is capped at $2,000.

Additionally, for the first time, the beneficiary can spread out the payments for the year with a capped monthly cost, instead of paying the pharmacy the full price when the medicines are purchase.

Steve Brauer · Answer

Its a great thing....you're out of pocket limit has been reduced greatly. Its a complicated formula, but generally, you will not have to pay more than $2000 for "covered" or formulary prescription drugs in a calendar year. The formula takes into account, what YOU'VE paid for your prescription and what the drug manufactures drug costs are. The trick is making sure that you have a Prescription Drug Plan that covers your prescriptions....with all of the changes, many plan have revamped their formulary offerings or moved drugs into different "tiers" to save money.

Answered by Steve Brauer on April 8, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Andrew Kramer · Answer

Well that's easy to answer, no more donut hole! The max you can pay for Rx's in 2025 is $2,000, not matter the retail cost of the Rx, or the Rx deductible of your plan. Both figures go towards the $2,000.

Answered by Andrew Kramer on July 22, 2025

Agent Licensed in FL

Answered by Andrew Kramer Medicare Insurance Agent

Marcie Barnes · Answer

Good news!  There is no Donut hole anymore.  Once you reach $2000 in out of pocket drug costs, the plan pays 100% for the rest of the year.

Carol Thompson · Answer

In 2025- once your cost shared amount has reached $2000- there is no cost to you. In 25’ there is also a payment plan that you can opt in with your insurance carrier to stretch out the cost of you medications throughout the year.

Answered by Carol Thompson on May 16, 2025

Broker Licensed in FL, LA, MI & NC, SC, VA & WI

Answered by Carol Thompson Medicare Insurance Agent

Linda Davies · Answer

The specific costs can vary depending on the plan.  Some plans may offer coverage that is more robust than the standard design, so there is some plan-to-plan variations.

Given the financial implications of the Medicare donut hole, understanding how your plan impacts your drug costs can help you make better decisions.  

Having the donut hole conversation is the best approach to maximizing your Medicare benefits and minimizing your costs.

Mel Stevens · Answer

The donut has been an issue in previous years costing people up to $8,000 a year when taking many medications or rather taking expensive medications.  The good news, in 2025 the max out of pocket has decreased from $8,000 to $2,000 max out of pocket.  Furthermore, Medicare recipients paying high medication costs can also set up a monthly payment plan to help stabilize the cost throughout the year.  
Some tricks of the trade. 
If you've been prescribed an expensive medication by your physician, it's also always a good idea to contact the manufacturer. Often times the manufacturer will offer a discount on the medication through a direct program. 
Also, double check your prescription drug plan because insurance companies have in and out of network pharmacies. For example, Medication X might be less expensive at CVS vs Walgreens of vice versa.

Robert Remin · Answer

Your max cost for covered drugs in 2025 cannot be more than 2000.00. Depending where you live odds very high your max cost for drugs and premium in 2025 will be less than when you had donut hole issues in the past

Answered by Robert Remin on May 19, 2025

Agent Licensed in NY, CT, FL & NJ

Answered by Robert Remin Medicare Insurance Agent

Robert Simm · Answer

Fortunately, you will not encounter the coverage gap in 2025, as this phase of prescription drug coverage has been eliminated.

Adam Morillo · Answer

Generally you will see less out of pocket for major medications now that they have implemented the $2,000 max out of pocket. Now you can have peace of mind with a more predictable annual maximum.

April Ryan · Answer

New Part D, Prescription Drug Plan laws were established for 2025 that state individuals will pay no more than $2,000 in drug costs for the entire year. You may also set up a payment plan with your drug plan carrier to help with copays and deductibles.

Answered by April Ryan on June 9, 2025

Broker Licensed in NC, SC & VA

Answered by April Ryan Medicare Insurance Agent

Al Saponar · Answer

It depends on your part D plan, and what prescriptions you take.

There also is a new rule establishing a Medicare Prescription Payment Plan to help spread out the copays for prescriptions over the remaining months of the year. If needed, it can be a huge benefit for many Seniors.

Brian Loquist · Answer

The great news is your total out-of-pocket maximum will be $2,000 for 2025 and $2,100 in 2026. The most important aspect to this is making sure all your medications are on Formulary. Please reach out to an industry professional for help!

Answered by Brian Loquist on July 9, 2025

Agent Licensed in SC, GA, NC & SD

Answered by Brian Loquist Medicare Insurance Agent

Mark Mabaquiao · Answer

The good news is that you won't be paying more than $2000 for all your covered medications for the year (not including the monthly premium). The bad news is that you might have to pay higher copays at the beginning of the year - almost like a reverse donut hole where you're hitting the donut hole immediately rather than towards the middle or latter end of the year. You do have the option to break up your out-of-pocket drug costs into monthly payments, so it lessens the amount you have to pay initially.

Answered by Mark Mabaquiao on June 3, 2025

Broker Licensed in NV, AZ, CA, FL, HI & IL

Answered by Mark Mabaquiao Medicare Insurance Agent

Michael Martin · Answer

The donut hole has been eliminated meaning each individual will pay no more than $2000 for the year for their prescriptions. If you know that you are going to be over $2000, you can contact your carrier directly and set up a payment plan, bypassing any copayments or deductibles in your plan.

Answered by Michael Martin on April 28, 2025

Broker Licensed in NJ, MD, MI & PA

Answered by Michael Martin Medicare Insurance Agent

I've been dreading hitting the donut hole each year. How will its elimination in 2025 change what I pay throughout the year?

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I've been dreading hitting the donut hole each year. How will its elimination in 2025 change what I pay throughout the year?

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