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

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.

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

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.

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 at Medicare4USA.com or call 214-989-7900. We’re here to help!

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.

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

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

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 & 9 other states

Answered by Ali Crouch 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.

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.

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.

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

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.com, costplusdrugs.com, simplecare.com, pharmacychecker.com, 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, your doing the math is essential to determine whether to go with "A" or "B" above. Good luck!

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

Steve Brauer · 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#steve-brauer

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.

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.

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.

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

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.

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

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, AZ, FL & 12 other states

Answered by Duane Boebel 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.

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.

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

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

Agent Licensed in TX

Answered by Bruce Resnick 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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