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

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.

Tony Capraro III · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/im-worried-about-the-donut-hole-in-my-part-d-plan-how-do-i-manage-my-medication-costs-once-i-enter-it#tony-capraro

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

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.

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, CT, FL & 11 other states

Answered by Amy Putrino 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.

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.

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.

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.

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, CT, FL & 10 other states

Answered by Deb Haley 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

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~

Answered by Diana Pedersen on April 20, 2025

Agent Licensed in WA & ID

Answered by Diana Pedersen Medicare Insurance Agent

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.

Kimberly 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.

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.

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.

Answered by Brandon Brown on April 26, 2025

Agent Licensed in KY

Answered by Brandon Brown Medicare Insurance Agent

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

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