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

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.

Aaron Solomon · Answer

You should see if you 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

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This question is out of date.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

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.

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

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

Larry Pereiro · Answer

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

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

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents Hub
A non-government resource website

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

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents HubA non-government resource website

Medicare Agents Hub
A non-government resource website