What phase is the donut hole in Medicare Part D?

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.

What are the stages of Medicare Part D in 2025?

Throughout the year, your prescription drug plan costs may change depending on the coverage stage you are in. If you have a Part D plan, you move through the CMS coverage stages in this order: deductible (if applicable), initial coverage and catastrophic coverage.

How do you beat the donut hole?

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.

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.

What is the catastrophic phase for Part D?

on Part D drugs if you reach the catastrophic coverage phase, which begins at a threshold of $8,000 in what's called true out-of-pocket (TrOOP) costs. For most people, you'll contribute roughly between $3,300 and $3,800 toward the cap of $8,000, and then pay $0 for your covered Part D drugs for the rest of the year.

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?

(This cap does not apply to out-of-pocket spending on Part B drugs.) For Part D enrollees who take only brand-name drugs, annual out-of-pocket costs at the catastrophic threshold will fall from around $3,300 in 2024 to $2,000 in 2025 (Figure 3).

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.

How long does the doughnut hole last?

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.

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.

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.

Does the medicare part D donut hole go away in 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.

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.

What percentage of Medicare patients hit the donut hole?

Separately Thursday, America's Health Insurance Plans, a trade group representing health insurers, said health insurance plan data show that about 10 percent of Medicare drug plan beneficiaries have reached the gap so far, with approximately 3 million expected to do so this year.

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.

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.

What is the catastrophic phase for Medicare Part D?

Catastrophic coverage is the last phase of Medicare Part D prescription benefits. In this phase, you have no out-of-pocket costs for covered medications. In 2024, the catastrophic phase is preceded by the donut hole phase. In this coverage gap, you have an $8,000 out-of-pocket threshold before the catastrophic phase.