How much is the donut hole in 2023?
Asked by: Janick Breitenberg | Last update: October 13, 2025Score: 5/5 (2 votes)
Is the medicare donut hole going away in 2023?
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.
What will the medicare donut hole be for 2024?
2024 was the last year of the donut hole. In 2024, you would enter the donut hole once you and your Part D plan together spent $5,030 on covered drugs.
How much is a medicare donut hole?
It's important to know that starting in 2025, the Part D donut hole is eliminated. Instead, once your out-of-pocket prescription drug costs reach $2,000, you enter the catastrophic coverage phase—and pay nothing for covered medications for the rest of the year.
Did Medicare get rid of the donut hole?
The Medicare Part D coverage gap, often called the donut hole, will be eliminated at the end of 2024. Starting in 2025, Part D plans will have a $2,000 out-of-pocket limit, which is expected to reduce prescription medication costs for millions of people.
Medicare Donut Hole Explained Simply
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.
Can I avoid the donut hole?
While it is not possible to completely avoid the Donut Hole in Medicare Part D prescription drug coverage, beneficiaries can take steps to reduce the amount of time they spend in this coverage gap.
How to get out of 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.
How much does a Tier 3 drug cost?
Tier 3: Preferred brand drugs
These are brand-name drugs that don't have a generic equivalent. They're the lowest-cost brand-name drugs on the drug list. This tier also includes some high-priced generic drugs. For most plans, you'll pay around $37 to $45 for drugs in this tier.
Will the 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 long do you stay in the donut hole with Medicare?
Generally, you stay in the donut hole until you pay the set limit that's determined by Medicare each year. In 2024, you enter the donut hole once you and your plan have spent $5,030 on covered drugs, and you remain in the coverage gap until your out-of-pocket costs reach $8,000.
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 is the maximum out-of-pocket for Part D in 2024?
Whether you're taking only brand-name drugs or a mix of brand-name and generic drugs, most people who reach the catastrophic coverage phase in 2024 will pay between $3,300 and $3,800 in out-of-pocket costs. In 2024, Mr. Alvarez takes $200,000 in Medicare Part D covered brand-name drugs.
How much will Medicare Part B cost in 2025 for seniors?
The Centers for Medicare & Medicaid Services (CMS) has announced that the standard monthly Part B premium will be $185.00 in 2025, an increase of $10.30 from $174.70 in 2024.
What are tier 5 Medicare drugs?
Tier 4: Non-preferred drugs – Higher-cost generic drugs and brand-name drugs with a lower-cost generic therapeutic equivalent are in this tier. Tier 5: Specialty drugs – This is the highest tier. Unique and/or very high-cost generic and brand-name drugs are in this tier.
How much does Medicare Part D cost per month for seniors?
The average estimated monthly Part D plan premium in 2025 is $46.50. Other factors can affect the cost of Part D including monthly premium, yearly deductible and copayments. High-income earners may pay a surcharge known as the “income-related monthly adjustment amount” (IRMAA).
What tier is gabapentin?
Medicare prescription drug plans typically list gabapentin on Tier 1 of their formulary.
Does GoodRx count towards the donut hole?
Avoid falling into the Medicare donut hole too soon
You can use your Medicare plan for your more expensive brand drugs, and use GoodRx to purchase your less expensive generic medications. The cost of drugs purchased under GoodRx will not count against your coverage limit - thus keeping you out of the donut hole longer.
Is there any way to avoid the donut hole?
Purchase your generic drugs and pay the cash price at a pharmacy that does not have your insurance information. Purchase your brand name drugs at another pharmacy and pay the insurance copay. This strategy will reduce your out-of-pocket costs in Stage 2, and often keep you from falling in the Stage 3 donut hole.
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 kind of financial assistance does a consumer receive who qualifies for a low-income subsidy?
Medicare's Part D Low Income Subsidy (also called LIS, or "Extra Help") helps enrollees pay for their prescription drug costs. People with incomes of up to 150% of the Federal Poverty Level (FPL) are eligible for LIS/Extra Help. Learn how the LIS/Extra Help program works, who can get this benefit, and how to enroll.
What is the Medicare donut hole for 2025?
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.
Is the donut hole the same for all Medicare Advantage plans?
All Medicare Part D prescription drug plans have a coverage gap known as the “donut hole” that temporarily limits the amount of drug costs that are covered. There are coverage phases for Medicare Part D beneficiaries during the calendar year determined by the federal government.