I'm in the donut hole and can't afford my medications. What are my options right now before the 2025 changes?
Answered by 14 licensed agents
This year of 2025 there are no known holes in the prescription drug plans. All drug plans are mandatory with this feeling of $2000 out-of-pocket expenses for the beneficiary. However, it is important to make sure that your drug plan includes your prescription drugs in their formulary so that you get full benefit of the out-of-pocket expenses.
All part D prescription drug plans should be reviewed annually
It's 2025 now. $2,000 max out of pocket and they will let you make equal monthly payments of $166.66. Be aware that to use that option, you need to ask your Part D provider for it in advance.
There is no doughnut hole,. Once you reach 2000.00 out of pocket in 2025 you are paid 100%. You have reached catastrophic coverage. There are options out there to help with the cost of your prescriptions. I myself have found help paying for prescriptions. If you need helpful information or have more questions contact us 800 859 4403
There is no donut hole this year. There are plans that have a deductible, which may be part of what's causing it. The only other option would be a higher priced drug plan that has no deductible on it.
This appears to be an old question...there's no donut hole in 2025, and COVERED prescription drugs are capped at $2000. The "covered" part of the statement is important, because plans are not required to cover all drugs, and if you enroll in a plan that does not cover all of your drugs it is possible to exceed the $2000 limit, maybe even by a large amount (depending on the cost of your non-covered drugs).
f you're facing high prescription costs within the "donut hole" of Medicare Part D & cannot afford your medications, several options are available before the 2025 changes. You can explore options like Medicare Extra Help, State Pharmaceutical Assistance Programs (SPAPs), & Patient Assistance Programs (PAPs). Additionally, consider switching to generic medications, mail-order pharmacies, & asking your doctor or pharmacist for lower-cost options. Before the 2025 changes, here's a breakdown of your options: 1. Medicare Extra Help: If you have low income & resources, you may qualify for Extra Help, which can significantly reduce your drug costs. You can apply for Extra Help by contacting your local Social Security office. 2. State Pharmaceutical Assistance Programs (SPAPs): Some states offer programs to help pay for drug plan premiums & cost-sharing. Check with your state's Department of Health or Social Services to see if you qualify. 3. Patient Assistance Programs (PAPs): Many pharmaceutical companies offer programs that provide discounts or free medications to those who qualify. You can find information about specific programs by searching the GoodRx website or by contacting the manufacturer of your medication. 4. Explore generic medications: If a generic version of your medication is available, switching to it can significantly lower your costs. 5. Consider mail-order pharmacies: Mail-order pharmacies often offer lower prices on prescription drugs than traditional pharmacies. 6. Shop around for the best price: Ask your pharmacist or use websites like GoodRx to compare prices at different pharmacies. 7. Talk to your doctor: Discuss alternative medications or strategies for managing your health that might be more affordable. 8. Consult a Medicare advisor or pharmacist: They can provide personalized guidance & help you navigate the system to find the most affordable options. Regarding the 2025 changes: The "donut hole" is being eliminated in 2025.
This question is out of date. The maximum coverage started in 2025 was no more than $2,000 max out of pocket for any prescriptions in the course of one calendar year. So this is no longer a relevant question
Depending upon your income and assets you might qualify for Extra Help to reduce your out of pocket expenses considerably. If you don't qualify for that, you might ask your Dr. about Manufacturer discounts that could be available for expensive medications. Now that we are in 2025, the donut hole cost share has been phased out!
For 2025 there is no donut hole. What there is, is a max out of pocket of $2,000 for the year. A couple of things I suggest is to reach out to your current prescription drug carrier and ask them to put you on a payment plan. That way you will have the same amount of payment for the prescriptions. Another option is to ask your Broker to help you apply for LIS, or any patient assist programs that may be available for a certain prescription.
