Is the donut hole going away in 2025?
Asked by: Celestine Legros | Last update: August 31, 2025Score: 4.7/5 (64 votes)
What will happen to the donut hole in 2025?
The Medicare Part D coverage gap explained. Good news for 2025: 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 is the out-of-pocket limit for Medicare in 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.
Will the donut hole ever end?
Key Takeaways. Through 2024, if you spent a certain amount on prescription drugs, you'd enter the Part D "donut hole" or coverage gap. As of 2025, the Medicare Part D coverage gap is eliminated.
What are the changes for Medicare in 2025?
For the first time, beginning in 2025, the drug law, known as the Inflation Reduction Act, requires all Medicare prescription drug plans (Medicare Part D plans) — including both standalone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage — to offer enrollees the option to ...
The Medicare Part D Donut Hole Is Going Away in 2025! What Does That Mean For You?
What will happen to Medicare in 2026?
The Contract Year (CY) 2026 MA and Part D proposed rule aims to hold MA and Part D plans more accountable for delivering high-quality coverage so that people with Medicare are connected to the care they need when they need it.
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.
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.
How much will Medicare cost in 2025 for seniors?
The standard monthly premium for Medicare Part B enrollees will be $185.00 for 2025, an increase of $10.30 from $174.70 in 2024. The annual deductible for all Medicare Part B beneficiaries will be $257 in 2025, an increase of $17 from the annual deductible of $240 in 2024.
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.
Why are people leaving Medicare Advantage plans?
Key takeaways: People leave Medicare Advantage plans because out-of-pocket costs vary between plans, network restrictions can cause frustration, prior authorization requests can delay care, and it can be difficult to use the additional benefits they provide.
How much will Medicare Part D cost in 2025?
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).
Why can't Medicare patients pay out-of-pocket?
In order to serve a Medicare patient, even if they want to pay out of pocket, [the clinics] have to have some sort of agreement with the patient. This law basically protects people who are sick right now and need care.
Are they getting rid of the donut hole?
Starting on January 1, 2025, the donut hole will be eliminated. And there will be a Part D $2,000 out-of-pocket spending cap, after which enrollees won't pay anything for covered medications for the rest of the year.
Why do people say not to get a Medicare Advantage plan?
Disadvantages of Medicare Advantage plans can include difficulty switching out of the plans later, restrictions on care access, limited provider networks, and limitations on extra benefits.
What 10 drugs will be reduced by Medicare?
- Eliquis.
- Jardiance.
- Xarelto.
- Januvia.
- Farxiga.
- Entresto.
- Enbrel.
- Imbruvica.
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.
Does everyone have to pay $170 a month for Medicare?
Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.
Will Medicare run out of money in 2026?
In 2023, HI income exceeded spending by $12.2 billion. Surpluses should continue through 2029, followed by deficits until the fund runs out entirely in 2036, according to the report. At that point, the government won't be able to pay full benefits for inpatient hospital visits, nursing home stays and home healthcare.
How do you beat the 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.
Which is better, Medicare Part D or GoodRx?
Consider using a GoodRx coupon instead of Medicare in the following situations: Your medication isn't covered by your Medicare plan. The medication costs less with a GoodRx coupon than with your Medicare copay. You don't expect to reach your annual deductible.
Is there a donut hole 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.
Will the Medicare donut hole ever go away?
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.
Is Eliquis covered by Medicare?
Yes. 100% of Medicare prescription drug plans cover this drug.