I'm in the donut hole and can't afford my medications. What are my options right now before the 2025 changes?

Question

Larry Dalton · Accepted Answer

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

Gary Church · Answer

The donut hole as of 2025 has been replaced with a deductible and a MOOP max out-of-pocket limit $2,000. Now, if you have some very expensive medications that are not on the formulary, they can be very costly and won't be covered by your drug plan.

Answered by Gary Church on September 19, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

Lt Col Tim Brown · Answer

There is no donut hole anymore. You can’t spend more than $2,000 in a calendar year. Call the number on the back of prescription drug card or your Medicare advantage plan and tell them you want to sign up for PPP (prescription payment plan). That will help tremendously. My drugs are expensive too and I signed up myself. Call the number.

Answered by Lt Col Tim Brown on July 6, 2025

Broker Licensed in TN, AL, CO & 10 other states

Answered by Lt Col Tim Brown Medicare Insurance Agent

Terri Reagin · Answer

The donut hole has actually been eliminated. You might want to talk to an agent about strategy on the card you are carrying and there is also a Medicare payment plan you can ask your carrier about.

Christopher Boyd · Answer

2926, the Donut Hole has been abolished, new guidelines limit Part D co-pays to $2100 if your drugs are in the plans formulary and your pharmacy preference are in the plan network.

Mark Maliwauki · Answer

There is no donut hole any longer. 

The Medicare Part D donut hole (coverage gap) was eliminated as of December 31, 2024. In 2025, there are only three phases of Part D coverage: a deductible phase, an initial coverage phase, and a catastrophic coverage phase. Beneficiaries will now have a $2,000 out-of-pocket spending limit before entering the catastrophic coverage phase. 

Once you hit $2k in out of pocket deductible, your Rx are covered for the rest of the year.

You can sign up for the Medicare Prescription Payment Plan where you can even out the cost of your Rx to a monthly payment amount for the year so you don't have to pay it all in the first few months. 

That is a great option.

Pamela Masters · Answer

I’m sorry to hear that your medications are expensive. There are options to possibly lower the cost on some things. Țry Goodrx. It may cost less with them. Also, find out if you are eligible for extra help. This will low the cost of your medications significantly. This is a government program based on your income. 

Also in 2025 the donut hole was eliminated. Yay! The cap for medications this year is $2000  

In 2026 things have changed a bit more. The cap is changing to $2100. Also a lot of the companies selling Medicare advantage are charging copayments for tier 1 and tier 2 drugs and coinsurance (percentage of the price) for tiers 3-5. This will change the amount you are paying. 
One last thing to add: even people who are on the dual plans will be paying copays for their medications based on  extra help prices.

Lynn C Shurtleff · Answer

This must be an old question because the donut hole went away for 2025.   We are now looking at 2026 and there is no more donut hole.

Vincent Murray · Answer

Well you are a little late for this question, lol.  Good news is there is no donut hole for 2025 and the maximum on drugs is $2000.  $2100 for 2026.

Justin Doherty · Answer

This question no longer applies as we're into September of 2025. That being said, there have been significant changes to drug coverage due to the removal of the donut hole.

Michael Denniston · Answer

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.

Answered by Michael Denniston on June 8, 2025

Agent Licensed in FL, AL, AR & 11 other states

Answered by Michael Denniston Medicare Insurance Agent

Steven Whetstine · Answer

I am receiving this question in August of 2025.  With that being said, I hope you have an agent or a broker that informed you that there is no donut hole in 2025.  

Also, if you find that you cannot afford your medications, there are a number of ways to tackle this scenario.

Every year, it is good to review your plan and see what your total estimated cost would be with premiums and copayments.  

Also, you can see if it is better to use your plan or look at other programs such as GoodRx, Clever Rx, Well RX, and other prescription discount plans.  

You can check to see if Medicare Savings Programs may be of assistance, Extra Help for Part D, or State Pharmaceutical Assistance Programs.

Some manufacturers do offer financial assistance with formularies of prescriptions.  

Finally, if all of your costs are more at the beginning of the year, you may want to check into the Medicare Prescription Payment Plan with your insurance carrier or MP3.  This allows you to budget your expenses over the course of the annual year rather than pay so much up front which makes it easier for beneficiaries for budgeting purposes.

Ravi Natarajan · Answer

At the time of answering this question, we are already in 2026. and donut hole does not exist. But in the past, clients could have reached out to their state pharmaceutical programs for assistance. Note: One can still use this service if faced with situations where their are not in the formulary of the plan they are on.

Answered by Ravi Natarajan on January 12, 2026

Broker Licensed in MA, AZ, CA & 12 other states

Answered by Ravi Natarajan Medicare Insurance Agent

David Bell · Answer

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.

Donna Lueders · Answer

If you're having a challenge paying for your medications you can apply for extra help via the site Medicare.gov. Additionally, you can contact your drug plan carrier and ask for the prescription payment plan options which spreads the medication costs over the course of the year. Another option would be to contact your senior center and ask if they have a prescription coverage program.

Answered by Donna Lueders on February 16, 2026

Broker Licensed in FL, GA, LA, NC & SC

Answered by Donna Lueders Medicare Insurance Agent

Steven Bleicher · Answer

The donut hole is no longer in effect! Since last year, the absolute maximum that any Medicare member could pay this year is still $2,000.00! This includes both generic and brand name drugs. You can also utilize the online discount websites in both the US and Canada. Just keep in mind that if you use the numerous Canadian pharmacies, that expense will NOT be applied against the $2,000.00 maximum.

Answered by Steven Bleicher on August 2, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Leslie Kaz · Answer

🧩 What changed — no more “donut hole”

As of January 1, 2025, the Medicare Part D “donut hole” (coverage gap) has been eliminated. 

Instead, there is now an annual out-of-pocket maximum: once a beneficiary has spent $2,100 (in 2026) on covered prescription drugs (deductibles, copays/coinsurance, etc.), the plan covers 100% of the rest of the year’s covered drugs. 

That means even if someone has many or expensive prescriptions, there is now a hard cap — no more open-ended drug costs. 

So — the “gap” phase that used to hit some people is gone. If you feared “entering the donut hole,” that fear should now be largely eliminated under 2026 rules (as long as they have a standard Part D or MA-PD plan).

James Stang · Answer

The donut hole was eliminated last year. If you are unable to pay your deductible ask your carrier to put you on a payment plan. The nice the cost of your medication reaches $2000, you will not pay and more copays.

Answered by James Stang on September 4, 2025

Agent Licensed in OH

Answered by James Stang Medicare Insurance Agent

Steven A James, MBA · Answer

Firstly, the "Donut Hole"/Coverage Gap was eliminated for 2025 as there is now an annual cap of $2,000 for qualified prescription drugs.  The cap will be $2,100 in 2026.

These caps pertain to standalone prescription drug plans as well as those included in a Medicare Advantage plan.

Steven A James, MBA
Contact us.

Cleo Martin · Answer

An answer to your question in 2025 and in 2026: There's no donut hole, it's gone. From the deductible, which in 2026 is going to be $615, to the payments. And then once you and others have reached $2,100, then your drugs will be paid for.

So what options do you have? You've missed the open enrollment because it ended December 7th. Unless you have a Medicare Advantage plan that you've had, then you can make a switch from January 1st to March 31st. You could change your Medicare Advantage card to go better with your drugs. You should always review your drugs with the card that you got to see if there's something better out there. Usually, an agent can do it, they do it for free, and that way you're going to get the best situation for yourself.

Geney Ruesga · Answer

You can apply with the Drug Plan for a 12-month Payment plan, you can fill out an application to apply for extra help

Mal Varlack · Answer

It is now 2025 so this question doesn’t apply or is relevant. You have an affordable option in 2025 as meds are now being capped at $2000.

Aaron Solomon · Answer

You should see if your quality for help from your state. The program is called LIS. It is based on your income.

Michael Crocker · Answer

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).

Answered by Michael Crocker on April 7, 2025

Broker Licensed in SC

Answered by Michael Crocker Medicare Insurance Agent

Areasha Lockhart · Answer

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.

Answered by Areasha Lockhart on May 27, 2025

Broker Licensed in CO, IA & ME

Answered by Areasha Lockhart Medicare Insurance Agent

Fred Manas · Answer

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.

Answered by Fred Manas on May 19, 2025

Agent Licensed in NY, CT, DC & 7 other states

Answered by Fred Manas Medicare Insurance Agent

Gary Henderson · Answer

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

Answered by Gary Henderson on April 11, 2025

Agent Licensed in TX, AK, AL & 46 other states

Answered by Gary Henderson Medicare Insurance Agent

Mary Brown · Answer

Good news, Medicare Part D no longer has a “donut hole.” In 2026, covered prescription drug costs are capped at $2,100 per year, helping make medication expenses more predictable. A local Medicare agent can also help review your plan and look for ways to lower your costs even more.

Answered by Mary Brown on May 19, 2026

Broker Licensed in NJ, DE, FL & NC, OH, PA & TX

Answered by Mary Brown Medicare Insurance Agent

Andrew Kramer · Answer

There is no "donut hole" in 2025. And we are in 2025, so there is no "before." Your Rx cap is $2,000.

Marcie Barnes · Answer

January 1 2025 the "donut hole" was eliminated.

Te maximum out of pocket for 2025 is $2000.  Please contact your insurance carrier to find out why your prescriptions are not covered.

Todd Bostic · Answer

In 2025, there is no longer a donut hole. You don’t have to worry about that anymore. Medicare wants to make prescriptions more affordable.

Deborah Webster · Answer

You can call your drug carrier and have them apply for a payment plan to spread the cost of your medications over the whole year.

Jennifer Kalbach · Answer

The donut hole is no longer an issue, they covered that gap (this only applies for covered drugs as non covered formularies do not count towards the out of pocket cost).

Joseph Peck · Answer

As of 2025,there is no longer a donut hole. Pricing will not raise after the deductible has been met. If you end up paying 2000 out of pocket for Medicare covered prescriptions from a network pharmacy, your prescriptions will then become $0 for the remainder of the year.

Answered by Joseph Peck on July 22, 2025

Agent Licensed in MI, AL, CO, KS & TN

Answered by Joseph Peck Medicare Insurance Agent

Don Hansford · Answer

This is a question that no longer applies as the donut hole was eliminated effective Jan. 1, 2025. This has made the Part D much easier to understand for the consumer as they now only have to deal with their deductible, Initial coverage and catastrophic coverage. No more big surprises in the middle of the year.

Answered by Don Hansford on February 10, 2026

Broker Licensed in TX

Answered by Don Hansford Medicare Insurance Agent

Brent Mowery · Answer

The "Doughnut Hole" ended on December 1, 2024. As of January 1, 2025, the most you will spend out of pocket is $2000.00 annually. If you are having a difficult time paying for your prescriptions, I can offer the following advice:

1. Ask your prescribing doctor for samples.

2. See if a generic medicine is available for "name brand " medications.

3. If you are taking an expensive medication(s), ask the manufacturer if there are any "Patient Assistance Programs". There are income limits in order to qualify.

4. If you have a lower income, it is possible you may qualify for "Low Income Assistance" (Extra Help) through Medicare. It may be possible to qualify for Medicaid through your state.

If I can assist, please contact me. Thank you!

Glenn Alterman · Answer

Nothing to worry about as 2025 is here and max out of pocket is $2000 plus whatever your part D  deductible is

Bud Griffin · Answer

As of 1/1/2025 Medicare no longer has a coverage gap (donut Hole). Today is 10/27/2025 the donut hole is nonexistant (does not exist) in 2025. Consequintly, you are not in the donut hole.

Claudia Englert · Answer

There is no donut hole or gap this year. The maximum out of pocket for outpatient prescription drugs for this year is $2,000. and then no more co-pays. The maximum out of pocket for next year 2026 has been to $2,100.

Answered by Claudia Englert on November 20, 2025

Broker Licensed in OH

Answered by Claudia Englert Medicare Insurance Agent

Larry Pereiro · Answer

Contact your state health department or the manufacturers to receive the potential of discounted pricing

Tony Merwin · Answer

I’m a little confused because as of 2025 there is no more donut hole or coverage gap. They’re certainly still a deductible on many plans otherwise catastrophic phase would kick in at $2000 in total drug costs annually. That cap is going up to 2100 next year. I’d be concerned that all of your prescriptions are included in your plans formulary list otherwise looking into the Medicare prescription payment program might be useful. You would want to contact your plan directly to get information on that.

Answered by Tony Merwin on July 11, 2025

Broker Licensed in TX, AL, AR & 29 other states

Answered by Tony Merwin Medicare Insurance Agent

Ray Rios · Answer

The Donut Hole is no longer in place since the beginning of 2025. The current True Out of Pocket is $2,000. In 2026, the Most you will pay is $2,100. Contact me.

Robin Duffey · Answer

Last year Medicare removed the donut hole and for 2025 the max medication copays is 2000 annually and for 2026 the max copays for medications will be 2100. robin :)

Raid Alemam · Answer

You can ask your doctor to find cheaper generic or even brand name drug that can save you money using mail order pharmacy and asking your doctor tor about formulary exception, you can also use good rx to save high medication costs , you also can ask Medicare for extra help to help with drug cost.

Answered by Raid Alemam on October 13, 2025

Broker Licensed in TX, CA, CO & 7 other states

Answered by Raid Alemam Medicare Insurance Agent

Ross Landon · Answer

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!

Answered by Ross Landon on April 10, 2025

Agent Licensed in UT

Answered by Ross Landon Medicare Insurance Agent

Jason Marshall · Answer

There are online discounts that can be assessed. I’ve even helped members get tier exceptions from carriers and even contacted the drug manufacturers for discounts and low cost samples until the new plan year begins.

Answered by Jason Marshall on November 16, 2025

Agent Licensed in CA

Answered by Jason Marshall Medicare Insurance Agent

Matthew Moreno · Answer

You could try to do discount drugs like good rx or clever rx for prescriptions in the meantime. Another option is by going to the manufacturer and let them know and they might be able to give you a discount as well.

Answered by Matthew Moreno on August 27, 2025

Broker Licensed in IL, AZ, FL, TX & VA

Answered by Matthew Moreno Medicare Insurance Agent

Steven Maicus II · Answer

While you need immediate solutions, be aware that major changes are happening in 2025, including the elimination of the "donut hole" and a new $2,000 out-of-pocket spending cap, which may help you further in the future.

Answered by Steven Maicus II on November 5, 2025

Broker Licensed in NY

Answered by Steven Maicus II Medicare Insurance Agent

Holt Rushing · Answer

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.

Doris Youngman · Answer

The donut hole was eliminated this year....2025.... after you have paid the deductible and your share of the $2,000 maximum, you have no copays for the remainder of the year.

Tammy Monjaras · Answer

Technically, there is no longer a “donut hole”. There is a maximum out of pocket of $2000 each year for prescription medication. Call your insurance company to find out where you are in prescription spending and find out what your options are.

Answered by Tammy Monjaras on September 6, 2025

Agent Licensed in OH, IN & KY

Answered by Tammy Monjaras Medicare Insurance Agent

Tabitha Self · Answer

As of 1/1/2025, the donut hole was eliminated in favor of a maximum out of pocket of $2100 for prescription drugs with a Standalone PDP plan OR a MA-PDP plan. However, it is important to meet with a licensed Medicare broker to review your Medicare Part D options annually during Annual Enrollment Period from Oct 15 - Dec 7 to ensure you are on the best plan possible for the specific prescriptions you take.

Answered by Tabitha Self on August 27, 2025

Broker Licensed in TN & FL

Answered by Tabitha Self Medicare Insurance Agent

Elenys Peraza · Answer

Starting January 1, 2025:
 The donut hole will be eliminated, and there will be a $2,000 annual cap on out-of-pocket drug costs. Beneficiaries can also spread costs evenly throughout the year, instead of paying up front.

Theresa Furth · Answer

As it relates to the donut hole, as of this year it is officially gone. Presently, there's a $2,000 annual cap on out-of-pocket drug costs for all Part D enrollees. If you are still having issues affording your medications and your income and assets are below certain limits, you may qualify for Extra Help or a Manufacturers Assistance Program. Check with your local Social Security or SHIP office.

Answered by Theresa Furth on October 30, 2025

Agent Licensed in VA, FL, ME & 5 other states

Answered by Theresa Furth Medicare Insurance Agent

Dawn Lathe · Answer

Before the 2025 changes, you can find financial assistance by checking for generic alternatives to your medications, looking into pharmaceutical assistance programs, applying for the federal "Extra Help" program, and exploring State Pharmaceutical Assistance Programs.

Answered by Dawn Lathe on November 3, 2025

Agent Licensed in NC

Answered by Dawn Lathe Medicare Insurance Agent

Ida Washington · Answer

The donut hole has been eliminated.  Once you reach your annual amount of $2100, you will pay $0 for plan covered Part D and Excluded drugs.

Belinda Lang · Answer

The "Donut Hole" does not exist anymore. Perhaps you got a new medication that requires the "deductible to be met". If you are now on a new medication, there may be vouchers, or samples from your doctor, or use the CostPlus, or PharmStore, or CleverRX, etc to try to find some discounts. Sometimes your pharmacist is aware of where best to go for the discount on that particular medication.

Answered by Belinda Lang on September 22, 2025

Broker Licensed in ID, AR, AZ & 16 other states

Answered by Belinda Lang Medicare Insurance Agent

Brenda Aguilar · Answer

explore manufacturer and patient assistance programs, use coupons from services like GoodRx, and ask your doctor about switching to a generic or cheaper brand-name drug.

I'm in the donut hole and can't afford my medications. What are my options right now before the 2025 changes?

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I'm in the donut hole and can't afford my medications. What are my options right now before the 2025 changes?

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