How do you avoid the donut hole in Medicare Part D?
Asked by: Melissa Hackett | Last update: June 28, 2025Score: 4.8/5 (45 votes)
Are there any Medicare Part D plans without a 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.
How to get around Medicare donut hole?
- 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.
Is there any way to avoid the donut hole?
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.
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.
Medicare Part D Explained | (And How To Avoid The Donut Hole)
Will the donut hole go away in 2025?
Even though the “donut hole” will close in 2025, there are steps you can take now to avoid extra costs associated with the coverage gap in 2024. You could compare prescription drug plans each year to make sure your plan offers the best coverage for your medications.
Can I use GoodRx even if I have Medicare Part D?
Resources like GoodRx provide discounts on medications separate from insurance. So even if you have Medicare, you can use GoodRx coupons.
Is there any insurance that covers the donut hole for Medicare Part B?
No. There is no insurance that can help you cover costs in the donut hole. It's important to note that some Medigap or Medicare supplement plans cover deductibles, coinsurance, and copayments for Medicare Part A and Part B only.
What will the Medicare donut hole be in 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.
Does Medicare donut hole start over each year?
Each stage of Part D is like a steppingstone throughout the year. The Medicare Part D donut hole is the third stage. The four stages start over on Jan. 1 of each year.
Will Medicare ever get rid of the donut hole?
Yes, the plan design for Medicare Part D prescription medication benefits will eliminate the donut hole beginning January 1, 2025. This change is a result of provisions in the Inflation Reduction Act of 2022 to reduce prescription medication costs for Part D enrollees and the Medicare program.
What is the maximum out-of-pocket for Part D in 2025?
In 2025, the coverage gap will be eliminated, and annual out-of-pocket Part D costs are capped at $2,000. This means if you take high-cost medications covered by Part D, you could see major savings. After meeting the out-of-pocket limit, you pay $0 for covered drugs for the rest of the year.
How to get out of the donut hole Medicare?
Once total spending for your covered drugs exceeds $6,550 (the “catastrophic coverage” threshold for 2021), you are out of the coverage gap and you will pay only a small co-insurance amount. For more from Medicare on coinsurance drug payments, click here.
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 Medicare Part D does not cover?
- Drugs used to treat anorexia, weight loss, or weight gain. ...
- Fertility drugs.
- Drugs used for cosmetic purposes or hair growth. ...
- Drugs that are only for the relief of cold or cough symptoms.
- Drugs used to treat erectile dysfunction.
What is the $2000 limit for Medicare Part D?
Thanks to the Inflation Reduction Act, in 2025 annual out-of-pocket costs will be capped at $2,000 for people with Medicare Part D.
Has the donut hole been eliminated?
The donut hole has vanished.
Plans can charge from nothing up to that limit. Initial Coverage: Drug plan members are responsible for 25% of the cost of drugs. The plans will likely continue to charge a copayment or coinsurance until the member reaches the threshold, $2,000.
Can you use GoodRx if you are in the donut hole?
The cost of drugs purchased under GoodRx will not count against your coverage limit - thus keeping you out of the donut hole longer. It's important to note that the amount you pay when using GoodRx does not automatically count towards your deductible or getting you out of the donut hole either.
How do you qualify for $144 back from Medicare?
- Be enrolled Original Medicare (Parts A and B)
- Pay your own Part B premium.
- Live in the service area of a plan that offers a Part B giveback.
How can seniors afford Eliquis?
Patients who have prescription insurance through Medicare pay, on average, $55 per month. And 5 out of 10 ELIQUIS patients pay $40 or less. Low-Income Subsidy patients may pay $0 to $11.20 per month through the Social Security Administration's Extra Help4 program. Use this link to learn about Extra Help.
Is GoodRx better than Medicare Part D?
GoodRx cash prices are not always cheaper than Medicare Part D copays, but they can be. GoodRx is a great resource for finding the most affordable price on many prescriptions. It is especially helpful if you have just been prescribed a new medication or your plan has changed its pricing.
Can you use a copay card with Medicare Part D?
An individual enrolled in a Medicare prescription drug plan cannot use drug coupons to help them pay for their prescription medications while using their Medicare coverage. This rule applies to people enrolled in the following plans: Original Medicare (Part A and Part B) a Medicare (Part D) prescription drug plan.
Does Medicare Part D pay for all drugs?
Beginning on January 1, 2006, Medicare will pay for all or most of your prescription drugs. This change in coverage is called “Medicare Part D.”