I'm worried about the 'donut hole' in my Part D plan. How do I manage my medication costs once I enter it?

Answered by 5 licensed agents

Don't worry! The dreaded "donut hole" has been discontinued effective January 1, 2025. So you can not longer enter the donut hole. However, Medicare pays less to the insurance companies this year for your prescriptions so most Part D plans now have higher deductibles which will be offset by a $ 2,000 annual limit on the full price of a member's covered Rx costs, so members with expensive name brand drugs will be protected by the new rules. Be careful on this and make sure that all of your prescriptions are in fact covered by your Part D plan.

Answered by Clarence "Mark" Christiansen on April 2, 2025

Agent Licensed in WI, AZ, CA & 16 other states

Answered by Clarence "Mark" Christiansen Medicare Insurance Agent
The Donut Hole was closed for 2025. No more huge out of pocket costs. The plans look completely different now. Please let me know if you would like more information. Happy to discuss how this was accomplished.

Answered by Amy Putrino on March 25, 2025

Agent Licensed in RI, CT, FL & 11 other states

Answered by Amy Putrino Medicare Insurance Agent
There is no longer a "donut hole," thanks to the Inflation Reduction Act. Technically, it has been phased out.

Here’s the quick backstory: the donut hole was a gap in Part D coverage where, after hitting a certain spending threshold ($5,030 in 2025), you paid a bigger chunk of drug costs out-of-pocket until reaching the "catastrophic" phase ($8,000 in 2025). Pre-2020, you’d foot 100% of costs in that gap. By 2020, it shrank to 25% for both drug types, effectively "closing" it. Now, in 2025, you’ll never even feel a gap—once you spend $2,000 out-of-pocket (including deductibles and copays), Part D kicks in to cover 100% of your covered drugs for the year. No more weird middle zone. It’s simpler, cheaper, and a lot less stressful for anyone juggling multiple prescriptions.

Answered by Phillip Lovelady on March 25, 2025

Agent Licensed in TX

Answered by Phillip Lovelady Medicare Insurance Agent
The prescription drug (2025) law caps your out-of-pocket drug costs for covered drugs at $200o

The "Donut Hole" no longer exist.

There is also a payment option to help you manage your monthly expenses.

Answered by Robert Fracchia on April 1, 2025

Broker Licensed in MI, FL & NC

Answered by Robert Fracchia Medicare Insurance Agent
As of 2025 once you spend $2,000 out of pocket there is zero cost to you. Your part D plan picks up all costs.

Answered by Debra Weber on March 31, 2025

Broker Licensed in PA, DE, FL & 5 other states

Answered by Debra Weber Medicare Insurance Agent

Tags: Coverage Medicare Part D Prescription Drug

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