What is the Medicare prescription 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").

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 for Medicare Part B?

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.

Why can't you use GoodRx with Medicare?

However, GoodRx cannot be combined with your insurance or any federal or state-funded program such as Medicare or Medicaid. GoodRx is not insurance. If you choose to use a GoodRx coupon or your GoodRx Gold membership, it's important to ask the pharmacist not to run your prescription through your insurance or Medicare.

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 happens when you reach the donut hole?

They often have to pay thousands of dollars for prescription drugs until they cross this coverage gap. 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.

What is the Part D deductible for 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 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.

How to get out of Medicare donut hole?

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?

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 $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.

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.

How to save money on prescriptions on Medicare?

What is the catch to GoodRx?

“Keep in mind you cannot use GoodRx and insurance at the same time,” the company's website says. Using a GoodRx coupon means you're doing a “cash” payment for your medications. (In this context, paying “cash” means you're paying out of pocket — without insurance.)

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 do you qualify for $144 back from Medicare?

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.

How can I 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 happens to the Medicare donut hole 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.

Is Eliquis covered by Medicare?

Yes. 100% of Medicare prescription drug plans cover this drug.