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

Question

Michael Pyers · Accepted Answer

The doughnut hole was eliminated in 2005 by the Inflation Reduction Act. The maxumum out of poket is now $2000. After you reach the $2000 limit your covered Medication will be a zero cost share. Also, you can request to make monthly payments on the $2000.

Answered by Michael Pyers on April 11, 2025

Broker Licensed in OH & MI

Answered by Michael Pyers Medicare Insurance Agent

Gary Church · Answer

As of 2025, there are no more donut holes. The deductible is $590, and the max out-of-pocket is $2,000. Depending on your tier level, you may have to meet the deductible.

Steve and Sue Brauer · Answer

Hi, thanks for watching. So the question is, someone is worried about the donut hole in their Part D plan and how they manage their medication costs. Well, the donut hole went away as of January 1st, which is a good thing. The max you're going to spend for covered drugs, and that's an important part. They have to be covered drugs, meaning that your prescriptions have to be on the plan's formulary. Otherwise, it doesn't count. But your max out of pocket is $2,000 for this year and going forward.

But a little fun fact, if your Part D plan, whether you have a Medicare Advantage plan with a drug plan or a standalone drug plan, if you don't have a deductible on your Part D plan, you automatically get credit for the $590 deductible that a lot of plans have. So instead of $2,000 being your max, it's $1,410, which is a pretty cool thing. And most agents, even most Medicare agents, don't know that. But yeah, so that's the answer to that.

Mike Alexander · Answer

You should contact your insurer and sign up for the M3P program, Medicare prescription payment plan, also look at Canadian pharmacies and discount programs out there, and ask you Doctor to see if he has samples or knows of a discount plan

Answered by Mike Alexander on October 20, 2025

Broker Licensed in TX, AL, AR & 16 other states

Answered by Mike Alexander Medicare Insurance Agent

Mark Bilgere · Answer

The donut hole has been eliminated. It is no longer an issue for Medicare beneficiaries. The cost of drugs and drug plans have increased, but there is no longer a "donut hole".

Daniel Brechin · Answer

As of last year the donut hole is eliminated. PDP programs in 2025 had a 2000 cap. You will pay Deductable then pay copays untill you reach 2000 out of pocket. In 2026 the deductible then copays till you have spent 2100.

Answered by Daniel Brechin on December 7, 2025

Agent Licensed in AL, FL, KY, MS & TN

Answered by Daniel Brechin Medicare Insurance Agent

William Lawler · Answer

Hi, Bill Lawler here. There's no reason to be concerned about the donut hole in 2025 because there is no more donut hole. The ceiling for medications has dropped from $8,000 in 2024 down to $2,000 in 2025, with no donut hole. This will continue into 2026. Although the ceiling is raised to $2,100 instead of $2,000, I'm here to help.

Larry Dalton · Answer

The Inflation Reduction Act, signed into law back in 2022, officially closed the Medicare Part D “donut hole” as of January 1, 2025. This means the old coverage gap phase is gone, and the process for getting your prescriptions covered is now much simpler.

Starting in 2025, there’s a $2,000 cap on out-of-pocket costs for prescription drugs under Medicare Part D. Once you hit that cap, you won’t pay anything more for your covered medications for the rest of the year.

However, some plans still have deductibles and limitations, so it’s important to talk with a licensed agent to help you choose the right Part D plan for your specific needs.

Also, once you’re enrolled in a plan, Medicare will give you the option to spread that $2,000 cap over 12 months—making it easier to manage your expenses. That monthly payment program is offered directly through Medicare.

Terri Reagin · Answer

The donut hole was eliminated in 2025. The out of pocket max has been reduced to $2000 per year for covered drugs. In addition, consumers can ask the insurance carrier about being placed on the "Medicare payment plan" wherein they are allowed to break up the yearly cost into monthly payments and not pay anything at the pharmacy. We can always check with your carrier about that.

Answered by Terri Reagin on August 5, 2025

Broker Licensed in OK, AR, CO & 6 other states

Answered by Terri Reagin Medicare Insurance Agent

Voss Speros · Answer

There isn't any Donut Hole as of 2025.  Don't you fret about a thing. There is a $2000 max out of pocket for all drugs as of 2025, instead of the donut hole and an $8000 max.

Bill Wheeler · Answer

Good news ! As of 2025 the donut hole is no longer in effect. You will stay at your current pricing untill you reach max out of pocket which is $2000.0. After that you do not owe for prescriitions.

Pamela Masters · Answer

There is no longer a donut hole. With the inflation reduction act the donut hole disappeared this year. You go straight from the initial stage to the catastrophic stage.

Tony Capraro III · Answer

I'm worried about the donut hole in my Part D plan. How do I manage my medication costs once I enter it? Great news for 2025: there is no more donut hole. As of 2025, the maximum out-of-pocket for prescriptions will be $2,000 per individual. For my clients, that's huge, because I've had clients who have spent $5,000, $6,000, or even $7,000 in the past years on medicines due to cancer or heart issues. So good news for you, my friend, whoever asked this question: there is no more donut hole. It will be a maximum out-of-pocket of $2,000 for prescriptions. Work with someone like myself who can go over Medicare Supplement, Medicare Advantage, and Prescription Part D plans. I've worked with clients for the last decade to help them make the right decisions. I'm Tony Capraro, I'm on Kelly Street in Manchester with State Farm. Let us help you, we'd be glad to.

Lynn C Shurtleff · Answer

The donut hole no longer exists.   Part D plans changed completely in 2025. I would advise reviewing these changes on Medicare.gov.

Ray McCauley · Answer

there is no longer a donut hole. There is now a maximum out-of-pocket for cover prescription drugs covered under your plan of $2100. You can spread that $2100 out over the course of the year.

Clarence &quot;Mark&quot; Christiansen · Answer

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

Steven Graves · Answer

Thank you for your great question—I have some excellent news!

Starting January 1, 2025, the Medicare Part D coverage gap, commonly known as the “donut hole,” will be eliminated.

All Part D plans will feature a maximum out-of-pocket limit of $2,000 per year. Once you have paid $2,000 out-of-pocket for your prescription drugs, your medications will be covered at no additional cost for the remainder of the year.

This change applies to all Part D prescription drug plans.

If you’d like assistance reviewing your current Part D plan or exploring options that could help you save money, please don’t hesitate to contact us. We’re here to help!

Michael Denniston · Answer

There is no more doughnut hole. The donut hole in Medicare Part D plans was a coverage gap where beneficiaries paid more for prescription drugs after reaching a certain cost threshold. This gap was eliminated in 2025, and instead, there are three phases of coverage: a deductible phase, an initial coverage phase, and a catastrophic phase. The catastrophic phase means beneficiaries will not have to pay anything for covered drugs for the rest of the year once their out-of-pocket costs reach $2,000. This change is part of the Inflation Reduction Act and aims to reduce out-of-pocket costs for Medicare beneficiaries. Contact me for more info.

Answered by Michael Denniston on July 23, 2025

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

Answered by Michael Denniston Medicare Insurance Agent

Steven Whetstine · Answer

As of 2025, the "Donut Hole" was eliminated.  You would have maximum out of pocket limits each year.  If you have costly medications that require you to make a major payment up front, you can consider the Medicare Prescription Payment Plan also called MP3.

The Medicare Prescription Payment Plan does not reduce the costs of your medications.  Rather, it allows you to spread the costs of your medication over the calendar year which can make it easier for budgeting purposes.

Darlene Murphy · Answer

As of 2025 there is no longer the 'Donut Hole.' By eliminating the donut hole, Medicare Part D prescription plans will switch to a three-phase design that includes the deductible phase, initial coverage phase, and catastrophic coverage phase.

Answered by Darlene Murphy on July 14, 2025

Broker Licensed in CA, AZ, ID & 7 other states

Answered by Darlene Murphy Medicare Insurance Agent

Michelle Sparks · Answer

The Medicare "donut hole," which refers to a coverage gap in the Medicare Part D prescription drug benefit, was eliminated January 2025. This change was a result of the Inflation Reduction Act, which aims to make prescription drugs more affordable for Medicare beneficiaries.

Previously, beneficiaries faced a coverage gap (the donut hole) where they had to pay a larger share of their prescription costs after reaching a certain spending threshold. 

The new rules established a maximum out-of-pocket limit of $2,000 for Medicare Part D beneficiaries. This means that once beneficiaries reach this limit in out-of-pocket costs for covered medications, they will not have to pay any additional prescription drug costs for the rest of the year.

Carly Cusack · Answer

You will not fall into the donut hole because it doesn't exist anymore. Under the Biden administration they eliminated the donut hole. In 2026 your max out of pocket for prescription drugs is $2,100.00.

Answered by Carly Cusack on January 19, 2026

Broker Licensed in OR & WA

Answered by Carly Cusack Medicare Insurance Agent

Mark Zaruba · Answer

Ever since the Inflation Reduction Act was passed, Part D plan recipients will pay a maximum of $2100 Out-of-pocket cost annually for their Part D plan deductible, co-pays and co-insurance. If the deductible phase causes budget unease, with the Medicare Prescription Payment Plan Part D payments can be evened out so you pay the same amount every month.

Answered by Mark Zaruba on February 12, 2026

Agent Licensed in WI & IA

Answered by Mark Zaruba Medicare Insurance Agent

Amy Putrino · Answer

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, AZ, CT & 12 other states

Answered by Amy Putrino Medicare Insurance Agent

Ryan George · Answer

Great news! At the time of this writing, in 2026, the donut hole is no longer applicable! If you are reading this in 2025 and beyond, you're good to go with no donut hole!

Michael White · Answer

Once the IRA (Inflation Reduction Act) was initiated the "Donut Hole" was removed. Now the maximum out of pocket for prescriptions is only $2000 for 2025 plans and $2100 for 2026 plans. Also, if you have a high cost on one, or more, of your prescriptions then you can work with the carrier to smooth your payments, or spread out your payments over time.

Answered by Michael White on October 1, 2025

Broker Licensed in IN, AL, CO & 16 other states

Answered by Michael White Medicare Insurance Agent

Eli Roque · Answer

THE DONUT HOLD WAS REMOVED FROM THE PARTD PLAN AS OF 2025 SO YOU AS A BENEFICIARYDON'T  NEEDED TO MANAGE IN WITH YOUR MEDICATION COST.

Ali Crouch · Answer

This year (2025), Medicare Part D no longer has a donut hole; however, checking your prescriptions every year is a vital part of ensuring you are on the correct Rx plan and knowing what your medications should cost throughout the year.

Answered by Ali Crouch on June 24, 2025

Broker Licensed in NE, AZ, CO & 11 other states

Answered by Ali Crouch Medicare Insurance Agent

Robert Fracchia · Answer

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.

Jillian Bellinger-Laing · Answer

The donut hole no longer exists in 2025. You have a $2000 out of pocket limit on your drug costs for this year. If your drugs have a high cost up front, the prescription plans are offering a prescription payment plan that you can sign up for to help spread out the costs for the year.

Answered by Jillian Bellinger-Laing on July 14, 2025

Broker Licensed in PA, DE, FL & 6 other states

Answered by Jillian Bellinger-Laing Medicare Insurance Agent

Joel McKinney · Answer

There is no more "donut hole." It was phased out at the beginning of 2025. Now, the phases of coverage are as follows:

Deductible phase: This is the first stage of prescription drug coverage. You will pay a deductible at the pharmacy, up to $615, before your plan "kicks in."

Initial coverage phase:  This is the phase where your plan either pays for a drug in full or pays part of your drug cost with you paying the rest.

Catastrophic coverage phase: After you reach $2,100 in out-of-pocket costs for your covered prescriptions, your plan will pick up 100% of the costs of your covered drugs for the remainder of the year.

Jason Miller · Answer

As of this year there is no more Part D Coverage Gap (Donut Hole). Plans go through a deductible phase (some have a $0 deductible) then straight to Initial Coverage where your costs remain constant until you reach a $2,000 out-of-pocket max. At that point you pay $0 for your medications. Just as a heads-up, the $2,000 out-of-pocket calculation can be tricky! It factors in a variety of expenses, so it's always best to use Medicare.gov (or let your broker do that) to get precise calculations each year.

Answered by Jason Miller on August 19, 2025

Broker Licensed in AZ

Answered by Jason Miller Medicare Insurance Agent

Phillip Lovelady · Answer

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.

Cris Zimmerman · Answer

The donut hole went away as part of the inflation reduction act in 2023.  Part D plans now have a maximum out-of-pocket of $2100 in 2026.

C. Faye Ricketts · Answer

Due to the Inflation Reduction Act has pretty much been eliminated the ‘donut hole’. As of 2025, a beneficiary has a maximum out of pocket limit, ($2100 in 2026). Once the troop costs for medication hits that limit, the out of pocket cost is $0.

Answered by C. Faye Ricketts on April 6, 2026

Agent Licensed in VA, AL, CO & 16 other states

Answered by C. Faye Ricketts Medicare Insurance Agent

Steven Bleicher · Answer

Due to the updated changes to one's drug coverage, the "old" donut hole has been eliminated. In the past, this dollar amount was $8,050/year. Now that there's a $2,000.00 maximum dollar amount to be spent on both Brand Name & Generic drugs, that is a tremendous savings for Medicare-eligibles. So, immediately with the turn of the calendar year, the "clocks starts ticking" since Medicare keeps track of all your drug expenses. So, in using the word "enter", (above) that used to be the way people would characterize the "dreaded" donut hole. But ......

In other words, on each January 1st of a new year, the monies spent by you, if not adequately covered by your Part D "Stand-Alone" Prescription drug plan OR your Medicare Advantage plan with drugs, there are two ways to pay for Rx's: A) thru your Part D(rug) plan, OR B) by investigating all of the US & Canadian discount drug websites. But bear in mind that you cannot do both for the same drug; you can only use one or the other! 

The most popular US sites are the following: GoodRx, costplusdrugs, simplecare, pharmacychecke, etc., etc. as there are many more than that. In addition, the Canadian sites do show the more popular brand name drugs at a very nice discount. But do bear in mind that anything purchased from a Canadian discount website is not going to be applied toward your $2,000.00 deductible. Thus, you're doing the math is essential to determine whether to go with "A" or "B" above. Good luck!

Andrew Zurbuch, MBA · Answer

The Coverage Gap of Medicare Part D, the donut hole, that you referred to was removed from Medicare Part D in January/2025 by the Inflation Reduction Act. It, the  Inflation Reduction Act, also instituted the $2,000 maximum out of pocket for prescriptions in 2025 for Medicare Beneficiaries. So don't worry about the Coverage Gap of Medicare Part D.

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare to get information on all of your options.

Steve Houchens · Answer

The donut hole no longer exist. It was ended in 2025. Drugs are capped in 2025 at $2,000 for the year and that cost goes up to a max of $2,100 for 2026. There is also a monthly payment plan set up now that you can enroll in if you choose that breaks that down monthly so you don’t have to come up with high out of pocket costs until you hit the max out of pocket.

Answered by Steve Houchens on October 8, 2025

Agent Licensed in KY & TN

Answered by Steve Houchens Medicare Insurance Agent

Ron Cronwell · Answer

Beginning with January 1, 2025, the donut whole was eliminated as a stage of medicare prescription plans. Currently the stages are: Deductible stage, Co-pay stage, and Catastrophic coverage stage.

Additionally, there is now a $2000 maximum out of pocket limit on out o  pocket payments for prescriptions under the plan.

Frank Carta · Answer

No more donut hole. Once your prescription drug costs are above $2,000 for 2025, you
no longer have to pay for your prescriptions.

Priscilla Ramos · Answer

The old Medicare Part D “donut hole” (coverage gap) no longer exists under the current rules starting in 2025. Instead of a gap where costs suddenly jump, Part D now has a simpler structure with an annual out of pocket cap (about $2,100 in 2026), after which you pay nothing for covered prescriptions for the rest of the year.

Answered by Priscilla Ramos on March 28, 2026

Agent Licensed in OH, AZ, FL & 5 other states

Answered by Priscilla Ramos Medicare Insurance Agent

Deb Haley · Answer

Good news! The coverage gap stage of prescription coverage, also known as the donut hole, was eliminated in 2025. There is now a $2,000 annual maximum out of pocket for your drug copays, after which you pay $0 copay for your medications for the remainder of the calendar year.

Answered by Deb Haley on April 11, 2025

Broker Licensed in MA, AZ, CA & 11 other states

Answered by Deb Haley Medicare Insurance Agent

David Silver · Answer

Today's question is, I'm worried about the donut hole in my Part D plan. How do I manage my medication costs once I enter it? The good news is the donut hole has been eliminated for 2025. You do not have to worry about the donut hole any longer. Just make sure that your medicines are on your plan's formulary and your costs will be capped at $2,000.

Casey Ahlbum · Answer

Good news for you, the "donut hole" went away for good in 2025!  All part D plans have the same structure now, a deductible and a maximum out of pocket. 

The standard deducible in 2026 is $615 dollars (individual plans can offer a lower deductible but it cannot exceed this amount), and the maximum out of pocket is $2100. 

Prior to reaching the deductible you pay 100% of the cost of your medicines through your plan at whatever co-payment or co-insurance is designated (based on the drug tier). In some cases that might be a $0 co-pay!  Once you reach the deductible, the plan begins to pay a larger share of the costs (i.e. a $20 co-pay may now only be $10) until you reach the maximum out of pocket limit. 

Keep in mind that the maximum only applies to covered medicines, so your choice of a prescription plan should be "prescription driven" based on the actual medicines that you take. Don't assume every Medicare Advantage plan's part D formulary is going to be the same. 

For many beneficiaries, a Medicare Supplement plan with a stand alone part D plan can give you the best combination of medical freedom, lower long term costs, and the best available prescription coverage for the medicines that you actually take.

Leslie Santos · Answer

In 2025, the donut hole is officially closing, 
Now you and your plan together pay until you reach the catastrophic coverage threshold.
Tip to avoid high copays review your plan every year.
During Open Enrollment (Oct 15–Dec 7), check if another Part D or Medicare Advantage plan covers your meds better. Formularies and costs change yearly.

Kim Gibas · Answer

In 2025, the Medicare Part D coverage gap, commonly known as the "donut hole," has been eliminated, and a significant change is the introduction of a $2,000 cap on out-of-pocket prescription drug costs. Here’s how you can manage your medication costs effectively.

The M3P, or the Medicare Prescription Payment Plan for 2025, is designed to provide a structured way to manage prescription drug costs for Medicare beneficiaries. 

By leveraging this strategy, you can effectively manage your medication costs and benefit from the improved structure of Part D in 2025. If you would like personalized support or further exploration of your options, feel free to reach out!

Kathy Detweiler · Answer

The Medicare Part D "donut hole" was officially eliminated as of December 31, 2024
Now the most you will pay for medication is 2,001 for 2026.
Part D prescription drug deductible
 The Part D prescription drug deductible is set by the federal government. In 2025 the amount is $590. In 2026 it will increase to $615.

Dee Ethridge · Answer

The donut hole is no longer. You now have a deductible to meet and once the deductible is met, and the total cost of your drugs (what you pay and the manufacturer pays) reaches $2000, there is nothing else for you to pay.

Answered by Dee Ethridge on October 4, 2025

Agent Licensed in FL, AL, GA, ND & SC

Answered by Dee Ethridge Medicare Insurance Agent

Jeffrey Barone · Answer

No need to worry. Effective 1/1/2025, the maximum out of pocket cost for all PDP plans is $2000.00. Once that number is reached, the carrier will be responsible for all drug costs. That number will increase to $2100.00 in 2026

Answered by Jeffrey Barone on September 25, 2025

Agent Licensed in RI, CT, FL, GA, MA & NY

Answered by Jeffrey Barone Medicare Insurance Agent

Duane Boebel · Answer

The good news is that the coverage gap (donut hole) was eliminated for the year 2025 prescription drug and Medicare Advantage plans having prescription drug coverage. Since January 1, 2006 until December 31, 2024 there was this coverage gap.

Answered by Duane Boebel on June 17, 2025

Broker Licensed in AL, FL, GA & 9 other states

Answered by Duane Boebel Medicare Insurance Agent

Nickey Baxter · Answer

Hello, the "donut hole" ended in 2025. There is currently a maximum out of pocket, for covered medications, of $ 2100.00. Once you reach that maximum the prescription costs are zero. This will not apply to a drug that is not on the insurance carriers formulary. If it is not on their formulary you will pay the full cost of the drug each time you fill the prescription. This is why you should evaluate your plan yearly, so you know you still have your expenses covered.

Answered by Nickey Baxter on October 22, 2025

Broker Licensed in UT, AZ, CO & 18 other states

Answered by Nickey Baxter Medicare Insurance Agent

Patricia Stiffler · Answer

The Coverage Gap (donut hole) was eliminated. However, a lot of the plans have a deductible of $615. Medicare has established a monthly payment plan where high-cost drug copays are spread out over the year. You need to contact your Part D RX plan about the monthly plan payment option.

Answered by Patricia Stiffler on March 30, 2026

Agent Licensed in CA

Answered by Patricia Stiffler Medicare Insurance Agent

Vachik Chakhbazian · Answer

The Medicare donut hole was eliminated on January 1, 2025, due to the Inflation Reduction Act, which replaced it with a yearly out-of-pocket (OOP) spending cap of $2,000 for covered drugs. Once you hit this $2,000 cap, you will no longer pay anything for your Part D covered drugs for the rest of the year

Answered by Vachik Chakhbazian on September 3, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent

Mary Brown · Answer

As of 2026, the old Medicare Part D “donut hole” coverage gap no longer exists, it was eliminated starting in 2025 and replaced by a straightforward structure with a $2,100 annual out‑of‑pocket cap, after which you pay nothing for covered drugs for the rest of the year.

Answered by Mary Brown on March 30, 2026

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

Answered by Mary Brown Medicare Insurance Agent

Andrew Kramer · Answer

The coverage gap, or "donut hole" is removed for 2026 and on. It's been replaced with a max out-of-pocket for the year, for all Part D Rx's of $2,000. That was accomplished in 2024 under Pres Biden's inflation reduction act, along with allowing Medicare to negotiate drug prices for brand name Rx's.

Answered by Andrew Kramer on May 16, 2025

Agent Licensed in FL

Answered by Andrew Kramer Medicare Insurance Agent

Carol Thompson · Answer

As of Jan 1, 2025, the donut hole does not exist any longer. There is a TROOP of $2000 and once cost shared between you and pharmacy reaches the $2000 there should not be any cost to you.

Mark Boone · Answer

The donut hole was eliminated before 2025 thus there is no longer a gap in coverage. Once you reach $2100 you no longer will pay anything for your prescription medications in 2026.

Todd Bostic · Answer

Beginning in 2025 the donut hole is now gone. However, you can pay out the cost of expensive medication over the course of the remainder of the calendar year.

Jack Mayer · Answer

Donut hole is over as of 2025, there is a deductible of 610.00 annually for medications and a copay or coinsurance for certain tiers and a true out of pocket of as much as 2,000

Deborah Webster · Answer

In 2025, Medicare changed the stages of the drug plans and eliminated the donut hole.
There are only 3 stages: Deductible, initial coverage, and catastrophic. Members enter a catastrophic stage where they pay $ 0 for medications once they have crossed the $2,000 mark.

Jennifer Kalbach · Answer

Currently, they have done away with the donut hole with regards to PDP's. The max out of pocket for Medicare Covered drugs is $2100 a year at which point you enter catastrophic coverage and have no more out of pocket costs. I think you should look yearly at what PDP plans cover the most cost sharing for the scripts you are on even though any carrier can change that at any time.

Answered by Jennifer Kalbach on March 17, 2026

Agent Licensed in KY

Answered by Jennifer Kalbach Medicare Insurance Agent

Karen Ansell · Answer

In 2026 there is not a donut hole. 
There are three stages.
1. the deductible, this can be $0 or maximum of $615.00
2. After the deductible You will pay $ copays or a % of the cost of your medications up to a max of $2100.00 out of pocket for the year.
3. After the $2100 you will pay $0

You want to make sure that the prescription plan you choose covers both your medications and your pharmacy of choice. You can call 1-800Medicare for a comparison.

Eizel Mere · Answer

The donut hole no longer exists in Medicare. Isn't that fabulous! Now you go from initial coverage to catastrophic, which sounds bad but is really good. 
Give me a call, I'd go over your questiona with you

Rodolfo Rojas · Answer

There is no donut hole any longer. Your deductible, the initial coverage and ones you get to 2000, you don't pay anything else for prescriptions that are covered in your plan.

Cheryl Lyons · Answer

You’re right to pay attention — the “donut hole” (coverage gap) used to be a big cost shock for Medicare Part D enrollees. Here’s how it works and how to manage costs:

1. Understand where you are in 2025

The donut hole is largely eliminated as of 2025 under the Inflation Reduction Act.

Instead of a gap where you paid more, there’s now a $2,000 annual out-of-pocket cap on covered drugs. Once you hit that, your Part D plan covers 100% of drug costs for the rest of the year.

So in 2025, the traditional “donut hole” surprise is mostly gone.

2. Strategies to manage costs (even before hitting the cap)

Check your formulary

Make sure your drugs are tiered favorably (generics or preferred brands are cheaper).

Use mail-order or 90-day supplies

Often reduces copays and helps you avoid multiple pharmacy visits.

Ask about generics or therapeutic alternatives

Cheaper options that work similarly to your brand-name drugs.

Track your out-of-pocket spending

Monitor how close you are to the $2,000 cap to plan timing and budgeting.

Check for extra help

If you qualify for Low-Income Subsidy (LIS/Extra Help), your out-of-pocket costs may be reduced further.

3. Consider a Medicare Advantage plan with Part D

Some MA plans include drug coverage and may offer lower copays or extra support programs for high-cost medications.

Can combine with OTC allowances or mail-order benefits.

✅ Bottom line

In 2025, the traditional donut hole is mostly gone.

Your main concern is reaching the $2,000 out-of-pocket cap, after which your drugs are fully covered.

You can manage costs by choosing preferred pharmacies, generics, and tracking your spending.

Jeffrey Sodikoff · Answer

There is NO donut hole anymore and you now have an out of pocket maximum on drugs covered in the plans formulary of $ 2100 in 2026

John Messler · Answer

The donut hole is no longer in effect. Beginning in 2025 prescription drug benefits significantly reduced the member cost sharing. Now there’s only a deductible. Which is typically the first $500 of the year. This is followed by the initial coverage. From $500 to $2000 and in 2026 will be $2100 beyond that amount. Medicare pays 100% and that period is called the catastrophic period. You also have the ability to have a payment plan to spread out that cost over the whole year.

Answered by John Messler on October 26, 2025

Agent Licensed in NH, ME, NC, OH, PA & TX

Answered by John Messler Medicare Insurance Agent

Roberto Alonso · Answer

The old "donut hole" phase was eliminated effective January first, 2025, and was replaced by a single out-of-pocket cap (OOP) for covered drugs: you pay up to that cap, after paying the plan's deductible for certain tiers, then the plan covers 100% of your covered Part D drugs for the rest of the year.

For 2026, the cap has been increased to $2,100 due to annual indexing, and the standard deductible is increasing.

Bruce Resnick · Answer

As of January 1 of this year, the "donut hole" is banished and gone. And now there is a $2,000 cap on RX expenditures too. The downside is that many insurers have either instituted or increased deductibles to make up for the increased costs for them to supply meds without a donut hole

Answered by Bruce Resnick on July 7, 2025

Broker Licensed in TX

Answered by Bruce Resnick Medicare Insurance Agent

Peggy Elliott · Answer

The maximum amount out of pocket is $2000 now, so there is no donut hole.  Check with your prescription drug costs to see if you will reach the $2000.

Al Saponar · Answer

The "donut hole" ended in 2024.
It has been eliminated, and there is now an out of pocket maximum of 2000 per year, which previously was up to 8000.
There are various Prescription options now.

Kim Mitchell-Hargis · Answer

There is no need to worry about the "donut hole" as it does not exist anymore.  Once you spend $2,000 in prescription drugs you pay no more the rest of the year.

Lyle Affleck · Answer

The 'donut hole' is no longer an issue when it comes to Medicare Part D (prescription drug) plans. During the Biden administration, CMS (Centers for Medicare & Medicaid Services) changed the way Part D plans were structured. They eliminated the dreaded 'donut hole' and capped the Maximum Out of Pocket (MOoP) for prescription drug plans at $2,000 (for 2025). Those MOoPs will likely increase year over year as will the premiums for the various prescription drug plans, but you won't have to worry about extra costs for receiving too many medications in a year.

Answered by Lyle Affleck on July 28, 2025

Agent Licensed in UT, CO, FL & 8 other states

Answered by Lyle Affleck Medicare Insurance Agent

Jamie Blake · Answer

Thanks to the Inflation Reduction Act, the donut hole was completely eliminated as of January 1, 2025.

Diana Muhammad · Answer

The donut hole has been eliminated.  All Part D Prescription Drug plans have alternative coverage benefits.  One pays for their drug costs in three phases, Deductible,  Annual Out-of-pocket threshold, and a Catastrophic phase once the Annual Out-of-pocket threshold has been met.   Your Broker can speak to you more specifically in choosing a plan that is best for you.

Elizabeth Henderson · Answer

As of 2026, there is no longer a 'donut hole'.  That ended in 2025.  There is an annual maximum out of pocket of $2100 and, once you reach that, you are in the 'catastrophic' phase where your prescription drugs copays are $0 for the rest of the year.

Darnel Brown · Answer

Well with the new limit for 2026 being $2,100 , once that is reached, the insurance carrier is responsible for all RX cost for that current year. 
A great assistance for helping with high cost of Brand RX

Akia Alexis · Answer

Because of the Inflation Reduction Act, the donut hole has been eliminated. In 2025, once a beneficiary meets the annual out of pocket cap of $2,000 for covered drugs, catastrophic coverage begins and therefore there is a $0 cost for the remainder of the year. The drugs have to be covered though.

Diana Pedersen · Answer

The "Donut Hole" has been eliminated for 2025. There is a cost for Prescriptions for the year of $2000 as long as they are covered medications. Also, there is a program call mppp or m3p that will help break down the costs over a 12 month period. Please give me a call and I can help explain this~

Crystal Burney · Answer

There is no more donut hole. Your max out-of-pocket for prescription drugs in the formulary is 2100.00 for 2026. There is also a program for those who cannot afford the initial cost of high-dollar drugs called the Medicare Prescription Payment plan. Most plans have very low to no cost for tiers 1 and 2 drugs and a deductible for tiers 3-5 drugs. Find a local insurance broker to help you navigate the drugs you are currently on and anticipated drugs, to find out what tier they are on, which affects your bottom dollar.

Stacy Cogar · Answer

Thankfully there is no longer a "donut hole". Contacting a licensed Medicare agent can review your drug costs on the new PDP plans that are now available for 2026 is the best way to learn about your drug costs

Margaret Brown · Answer

There is no longer a “donut hole” when it comes to Part D. Catastrophic coverage for 2026 will be reached at $2,100. The Inflation Reduction Act was implemented in 2025. Whether it is a Part D plan or a Medicare Advantage plan there is the option to opt in a MPPP (Medicare Prescription Payment Plan) to help manage your cost of prescriptions for the entire year.

Debra Weber · Answer

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.

Jennifer Dixon · Answer

There is no longer a donut hole.  Once you have paid $2000. your medicine will cost zero.  You can always make sure you are on the right plan by going to Medicare.gov and type in your medication.

Mike Sosso · Answer

The donut hole is no longer a problem in 2025. The Inflation Reduction Act of 2024 eliminated the Part D donut hole and mandated that seniors prescription costs would not exceed $2000 per year beginning in 2025 for all prescriptions included in the plans formulary.  

The challenge however is that many prescription plans changed thier formularies in 2025 and sent notices advising thier clients but many customers did not fully understand the cost changes or of prescriptions that thier plan would no longer cover.

Aimee Butler · Answer

The donut hole is gone as of Jan 1, 2025.  There is now a $2000 (for 2025) cap on the cost of medications.  The monthly premium of the RX Plan does not count toward the $2000.  Medications have to be listed on the plans formulary in order for them to count toward the cap.  For example if you were filling 3 prescriptions listed on your formulary and 1 prescription you purchased through something like GoodRx, the GoodRx payment would not go toward the $2000 cap.

Jeff Linabary · Answer

The donut hole was eliminated after 2024 and so in 2025, there was no Donut hole.  However, there was a $2000 Max prescription drug cost implemented for covered medications. Once you meet this deductible of accepted medications within your plan you should have no further medication expenses for the year.  There is also a payment plan available for large prescription drug costs to spread out over the year.

Fewee Bondad · Answer

There is no longer a donut hole for Part D plan.  There is only a MOOP - Maximum Out of Pocket for covered medications on your drug plans formulary.  For 2025 it was $2000.  Once that out of pocket expenses was reached, all other meds on your drug plans formulary is 0 cost.  For 2026 MOOP will be $2100.

Brandon Brown · Answer

Good news — starting in 2025, the donut hole (coverage gap) is officially gone under Medicare Part D. You’ll pay your deductible first (up to $590), then 25% of your medication costs until you hit $2,000 out-of-pocket. After that, your prescriptions are 100% covered for the rest of the year.

Cyle Gillman · Answer

In 2025 the donut hole as it was known went away. They introduced a maximum out of pocket expense for covered prescriptions of $2000.00 and a Prescription Payment Plan, which allows you to spread the cost of your medications over the year. 

This amount did increase for 2026 to $2100.00 for covered prescriptions. As long as your medication is covered on your providers formulary your expenses won’t exceed this amount.

Robert Gilman · Answer

Therr are many ways to cover the costs. Government assistance programs, prescription discount cards, generic drugs instead of brand name drug. Even different plans. You should review your plan yearly either a professional Medicare agent who can help you with this.