How can I avoid the Medicare donut hole?
Asked by: Vesta Powlowski | Last update: November 30, 2025Score: 4.5/5 (12 votes)
- Lower the costs of your prescription medications by choosing a Part D plan with a formulary that includes your medications.
- Shop around to see if you can find a pharmacy that offers your medications at a lower cost.
How to prevent donut holes in Medicare?
Generics: Talk to your doctor about whether any generics may be a good substitute for expensive brand-name drugs. If your medication is in a higher cost tier or not covered on your plan's formulary (approved drug list), you may want to ask for an exception to get the plan to cover it completely or at a lower cost.
Are there any Medicare plans that don't have a donut hole?
There is not a Medicare plan that covers the donut hole. You may wonder if a Medigap could help you avoid donut hole costs. Medigap policies are private Medicare supplement insurance plans that are sold to cover additional costs and some services not traditionally covered by Original Medicare.
Will Medicare ever get rid of the donut hole?
In 2025, the Medicare Part D coverage gap, also known as the “donut hole,” will be eliminated under the Inflation Reduction Act (IRA). Part D plan members will also enjoy the security of an annual maximum out-of-pocket cost for prescription drugs.
Is there any insurance that covers the donut hole?
Is there any insurance that covers the Medicare donut hole? While the federal government has shrunk the coverage gap, currently there aren't any Medicare Part D plans without a donut hole, even those included as part of a Medicare Advantage plan.
Medicare Part D Explained | (And How To Avoid The Donut Hole)
Does the Medicare donut hole go away in 2025?
The Inflation Reduction Act (IRA) signed by President Biden in 2022 will eliminate the Prescription Drugs Coverage Gap (known as the donut hole) for Seniors in 2025. Most Medicare drug plans have a coverage gap (also called the "donut hole").
How do you call a donut without a hole?
Jelly Doughnut
These classic doughnuts are typically round without a hole in the middle, and generally leavened with yeast. The center is stuffed with jelly, jam, or preserves (and sometimes chocolate!), giving you a burst of flavor with each bite.
How much do you have to spend to get out of Medicare donut hole?
Starting in 2025, Medicare no longer has a 'donut hole,' or coverage gap. In prior years, you paid up to 25% out of pocket for covered medications in the donut hole phase. Starting in 2025, once you reach the annual out-of-pocket cap ($2,000 in 2025), you're done paying out of pocket for the year.
What is the new Medicare rule for 2025?
Medicare Part D cap of $2,000
Beginning January 1, 2025, people with Part D plans through traditional Medicare and Medicare Advantage plans with prescription drug coverage won't pay more than $2,000 over the calendar year in out-of-pocket costs for their prescription medications.
What happens when you get out of the donut hole?
However, once a person crosses the donut hole, they reach “catastrophic coverage.” Once they reach this stage, they only need to pay about 5% of the cost of the prescription drugs. However, for many people in the U.S., getting to the stage of catastrophic coverage is problematic or impossible.
Is the donut hole in Medicare 2024?
The Medicare Part D donut hole or coverage gap phase of coverage no longer exists as of December 31, 2024. It was the coverage phase after the initial coverage period when you owed a higher or different percentage of the cost of your drugs.
How much does Medicare cost per month?
Here's what you'll pay for Medicare Part B: Premium: $185 per month, although you could pay more depending on your income. Higher-income beneficiaries: An additional $74 to $443.90 per month on your premium if your income exceeds certain thresholds. This is the income-related monthly adjustment amount (IRMAA).
What happens if you have a gap in health insurance coverage?
How long does a Short Gap in Coverage exemption last? For those who were uninsured for a period of less than three consecutive months during the year, the exemption will be granted for those months. You will need to claim a new exemption in future years if you experience these circumstances again.
What is the Medicare out-of-pocket maximum for 2025?
Starting in 2025, all Part D and Medicare Advantage plans will have a $2,000 annual cap on out-of-pocket prescription drug costs (this cap was previously $8,000). Once you hit this threshold, your costs for covered prescriptions will be $0 for the rest of the year.
What is the reason for the donut hole?
This gap in coverage was put into the plan to save the government money. While the bill was intended to assist seniors with their drug expenses, Congress wanted to limit public spending on the program. The “doughnut hole” gap in coverage was the mechanism chosen.
Can I use GoodRx if I'm in the donut hole?
Key takeaways:
You may want to consider using GoodRx instead of Medicare when Medicare doesn't cover your medication, when you won't reach your annual deductible, or when you're in the coverage gap phase (“donut hole”) of your Medicare plan.
Is the donut hole going away in 2025?
As in 2024, there is no beneficiary cost sharing above the annual OOP threshold in 2025. The coverage gap phase (also known as the “donut hole”) will be eliminated, which will result in standard Part D coverage consisting of a three-phase benefit: a deductible phase, an initial coverage phase, and a catastrophic phase.
Why are hospitals refusing Medicare Advantage plans?
Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. In 2023, Becker's began reporting on hospitals and health systems nationwide that dropped some or all of their Medicare Advantage contracts.
What are the top 5 medicare supplement plans?
💬 From our Nerds: What are the top five Medicare supplement plans? "Based on NerdWallet's Medigap rubric, I picked five best Medicare Supplement Insurance companies for 2025: AARP/UnitedHealthcare, Mutual of Omaha, State Farm, Anthem and Blue Cross Blue Shield.
How much is the donut hole now?
As of Jan 1, 2025, the Medicare Part D coverage gap (commonly known as the "donut hole") is gone. This major change, a result of the Inflation Reduction Act, simplifies prescription drug coverage by removing the coverage gap phase and establishing a $2,000 annual cap on out-of-pocket spending for covered drugs.
What is the deductible for Medicare Part D in 2024?
For 2025, under the standard benefit, Part D enrollees will pay a deductible of $590 (up from $545 in 2024), and will then pay 25% of their drug costs in the initial coverage phase until their out-of-pocket spending totals $2,000.
What are the changes to Medicare Part D in 2025?
The CY 2025 updates include the following: - A newly defined standard Part D benefit design consisting of three phases: annual deductible, initial coverage, and catastrophic coverage; - A lower annual out-of-pocket (OOP) threshold of $2,000; Page 2 2 - The sunset of the Coverage Gap Discount Program (CGDP) and ...
What is the difference between donut and donut holes?
The main difference between the two is that cake style donut holes use a leavener like baking soda or baking powder to bring rise to the bread, while a yeast style donut uses yeast.
Who invented donut holes?
Statue of Captain Hanson Gregory, inventor of the donut hole : black-and-white photoprint. Smithsonian Institution.
What does the 🍩 mean?
The Doughnut emoji 🍩 depicts a doughnut, a commonly eaten baked good. It is commonly used to represent real and metaphorical doughnuts, breakfast, bakeries and baked foods, snacks, coffee breaks, The Simpsons, and negative stereotypes of police officers.