Will the donut hole go away in 2025 Medicare Part?
Asked by: Jett Nienow | Last update: July 25, 2025Score: 4.3/5 (20 votes)
What happens to the Medicare donut hole 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").
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.
What are the changes coming to Medicare in 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.
Is there any way to avoid the donut hole in Medicare?
- 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.
The Medicare Part D Donut Hole Is Going Away in 2025! What Does That Mean For You?
Are they getting rid of the 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.
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.
Is there any insurance that covers the donut hole?
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 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.
Why are hospitals refusing Medicare Advantage plans?
Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. In 2023, Becker's began reporting on hospitals and health systems nationwide that dropped some or all of their Medicare Advantage contracts.
What is the Medicare income limit for 2025?
The 2025 IRMAA income brackets and Parts B and D surcharges have been announced. This year, Medicare beneficiaries with income over $106,000 (for single tax filers), $212,000 for joint filers and $106,000 (for married people that file separately) will pay the surcharge.
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.
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.
What is the maximum out-of-pocket for Part D in 2025?
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 donut hole end at the end of the year?
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.
What year will Medicare end?
A key trust fund underpinning the massive Medicare program has a new insolvency date: 2036, according to a new report from the Medicare trustees.
Is the donut hole going away in 2025?
Third, know that in 2025, the coverage gap (also called the “donut hole”) is going away and you will not have to pay anything for your covered drugs once you have paid $2,000 in out-of-pocket costs.
Will Medicare be around in 5 years?
Based on current projections from the Medicare Board of Trustees' 2024 report, the Medicare Part A (Hospital Insurance, or HI) trust fund is projected to be depleted in 2036, 12 years from now – an improvement of five years compared to the projected depletion date of 2031 in the previous report due to higher expected ...
What are the changes for Medicare in 2025?
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.
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.
What is the deductible for Medicare Part B in 2025?
The annual deductible for all Medicare Part B enrollees in 2025 will be $257, an increase of $17 from the 2024 deductible of $240.
How can I avoid the donut hole?
Discuss lower-cost drug alternatives with your healthcare professionals. Seek out discounts on medications. Choose generic drugs over brand-name drugs. Opt for in-network pharmacies only.
How do you get around the Medicare donut hole?
- Extra Help: Extra Help is a Medicare program that helps people pay for medications and other aspects of medical care. ...
- Medicaid: Medicaid is a federal program that helps low income individuals pay for healthcare.
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.