What is the donut hole for prescriptions?
Asked by: Miss Lavada Daniel | Last update: November 12, 2025Score: 4.9/5 (61 votes)
How long do you stay in the donut hole?
Once you enter the donut hole, you stay there until you've spent a specific amount for covered drugs. (People who qualify for the Extra Help program won't enter the coverage gap.) This amount changes each year, and it includes: What you've paid for the deductible, copayments or coinsurance for covered drugs.
How to get out of the 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.
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.
Will the donut hole go away in 2025 Medicare Part?
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.
Medicare Donut Hole Explained Simply
Is there a way to avoid the donut hole?
Tips on How to Avoid the Donut Hole Coverage Gap
Discuss lower-cost drug alternatives with your healthcare professionals. Seek out discounts on medications. Choose generic drugs over brand-name drugs.
What is the donut hole in social security?
Earnings above this threshold are not taxed for Social Security. The proposed reform suggests reinstating the payroll tax on incomes exceeding $400,000, creating a gap — or “donut hole” — between the current cap and $400,000 where earnings remain untaxed.
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.
Is Medicare getting 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.
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.
What is the out-of-pocket maximum for Medicare prescriptions 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.
What is an example of the donut hole for Medicare?
In 2024, for example, you reached the Part D donut hole when you and your plan had paid $5,030 for your medications. Prior to 2019, if you reached the coverage gap, you would have to pay 100% of your prescription drug costs in that period until you met the catastrophic coverage period spending threshold.
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.
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.
Is there a cap on prescription drug costs?
Trump's executive order does not change portions of Biden's Inflation Reduction Act that created a $2,000 out-of-pocket cap on prescription drugs, placed a $35 cap on Insulin, and allowed HHS to negotiate prices for high drug costs.
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 much can you make on social security and still get extra help?
You should contact Social Security for other resource exclusions. What is the income limit? To be eligible for Extra Help, your annual income must be limited to $22,590 for a person or $30,660 for a married couple living together.
How 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.
How long does the donut hole last?
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").
What is the donut hole procedure?
The donut hole was a temporary limit on what the drug plan would cover for drugs. Now all Medicare plans include a $2,000 cap on what you pay out-of-pocket for prescription drugs covered by your plan.
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.
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.
Is there a coverage gap 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.