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 24 licensed agents
Answered by Michael Pyers on April 11, 2025
Broker Licensed in OH & MI
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.
Answered by Larry Dalton on May 20, 2025
Broker Licensed in OK & TX
Answered by Tony Capraro III on April 16, 2025
Agent Licensed in NH & ME
Answered by Gary Church on May 21, 2025
Broker Licensed in Ca, AZ, NV & TX
Answered by Clarence "Mark" Christiansen on April 2, 2025
Agent Licensed in WI, AZ, CA & 16 other states
Answered by Amy Putrino on March 25, 2025
Agent Licensed in RI, CT, FL & 11 other states
Answered by Ali Crouch on June 24, 2025
Broker Licensed in NE, AZ, CO & 9 other states
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
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.
Answered by Michelle Sparks on June 3, 2025
Agent Licensed in KS & MO
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 Bill Wheeler on June 2, 2025
Broker Licensed in KY & IN
Answered by Deb Haley on April 11, 2025
Broker Licensed in MA, CT, FL & 10 other states
Answered by Steve Brauer on June 4, 2025
Broker Licensed in AZ & CA
Answered by Carol Thompson on June 18, 2025
Broker Licensed in FL, LA, MI & NC, SC, VA & WI
Answered by Andrew Kramer on May 16, 2025
Agent Licensed in FL
Answered by Jack Mayer on June 9, 2025
Agent Licensed in CA & NV
Answered by Rodolfo Rojas on June 23, 2025
Broker Licensed in NV, AL, AR & 22 other states
Answered by Diana Pedersen on April 20, 2025
Agent Licensed in WA & ID
Answered by Kimberly Hargis on May 31, 2025
Broker Licensed in TN, FL & KY
Answered by Debra Weber on March 31, 2025
Broker Licensed in PA, DE, FL & 5 other states
Answered by Duane Boebel on June 17, 2025
Broker Licensed in AL, AZ, FL & 12 other states
Answered by Jennifer Dixon on May 5, 2025
Agent Licensed in GA & TN
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.
Answered by Mike Sosso on May 13, 2025
Broker Licensed in TX, AZ, NC & SD
Answered by Brandon Brown on April 26, 2025
Agent Licensed in KY
Tags: Coverage Medicare Part D Prescription Drug
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