I'm in the donut hole and can't afford my medications. What are my options right now before the 2025 changes?
Answered by 22 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
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.
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.
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.
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.
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 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.
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.
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.
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).
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.
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
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.
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.
