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

Question

Melonie Wood · Accepted 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

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.

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.

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 Last year, folks paid a maximum of $8,050.00 in the donut hole and it has been replaced by the $2,000.00!!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.

Timothy Brown · 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

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

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

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.

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.

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.

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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