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What Is the Medicare Part D “Donut Hole”?
Reviewed by John Krahnert
The “Medicare donut hole” is a term commonly used to describe a gap in coverage that some Medicare prescription drug plan beneficiaries faced prior to 2025, depending on their drug costs and out-of-pocket spending amounts. It’s important to note that the Medicare donut hole was eliminated starting in 2025.
It may seem strange to draw a parallel between Medicare and donuts. However, the comparison can be used to illustrate the idea that in some cases, Medicare prescription drug plan beneficiaries could encounter a gap in coverage (i.e., the Medicare donut hole) before 2025.
Qualified beneficiaries can get Medicare prescription drug coverage through a Part D plan (PDP) or through a Medicare Advantage plan that includes Part D coverage (called a Medicare Advantage Prescription Drug plan, or MA-PD). It’s important for Medicare beneficiaries to understand how the Medicare Part D donut hole affects drug costs.
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Did the Medicare donut hole go away in 2025?
Yes, the Medicare Part D coverage gap was eliminated for 2025. Out-of-pocket costs for covered drugs will be capped at $2,000 for Part D enrollees, eliminating the Medicare donut hole.
Part D beneficiaries can also spread out payments for their out-of-pocket drug costs over the year, starting in 2025.
When Medicare Part D was first rolled out in 2007, and prior to the Affordable Care Act, beneficiaries paid 100% of drug costs while in the donut hole.
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Enrollment may be limited to certain times of the year. See why you may be able to enroll.
Can I lower my out-of-pocket Medicare drug costs?
You might be able to pay lower out-of-pocket prescription drug costs if your doctor switches you from a brand name drug to a generic drug or from a brand name to a less expensive brand name drug, if possible. Ask your physician whether this is possible based on your specific medical condition and health history.
Another option is to use mail-order pharmacies or take advantage of Pharmaceutical Assistance Programs available in your state or by the company that makes your drug.
People with specific income and resource limits may qualify for the Extra Help program, in which case they will not enter the donut hole. The Extra Help program is a government program, and you can contact Social Security toll-free for help completing the application by calling 1-800-772-1213 (TTY 1800-325-0778).
If you want more information about the Extra Help program, you can also call 1-800-MEDICARE (TTY 1-877-486-2048) or visit Medicare.gov.
Compare Medicare prescription drug coverage options
Request a free online plan comparison or call to speak with a licensed insurance agent and find out if any Medicare prescription drug coverage options available where you live cover your drugs.
About the author
Lisa Eramo is an independent health care writer whose work appears in the Journal of the American Health Information Management Association, Healthcare Financial Management Association, For The Record Magazine, Medical Economics, Medscape and more.
..Lisa Eramo is an independent health care writer whose work appears in the Journal of the American Health Information Management Association, Healthcare Financial Management Association, For The Record Magazine, Medical Economics, Medscape and more.
Lisa studied creative writing at Hamilton College and obtained a master’s degree in journalism from Northeastern University. She is a member of the American Health Information Management Association, American Academy of Professional Coders, Society of Professional Journalists, Association of Health Care Journalists and the American Society of Journalists and Authors.
Lisa currently resides in Cranston, Rhode Island with her wife and two-year-old twin boys.
Website: LisaEramo.com
LinkedIn: Lisa Eramo
Twitter: @Lisa_Eramo
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