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Major changes in 2025 include Medicare Advantage plans and a new $2,000 out-of-pocket max under Part D, eliminating "donut hole" coverage gap.
The donut hole will disappear after 2024 and be replaced by a new $2,000 out-of-pocket cap in 2025. This change, due to the Inflation Reduction Act, affects all Medicare plans.
Millions of Medicare enrollees are likely to see relief in 2025 when a $2,000 cap on out-of-pocket prescription drug-spending goes into effect.
The Medicare Part D coverage gap (informally known as the Medicare donut hole) was a period of consumer payments for prescription medication costs that lay between the initial coverage limit and the catastrophic coverage threshold when the consumer was a member of a Medicare Part D prescription-drug program administered by the United States federal government.
Prior to 2010, enrollees were required to pay 100% of their retail drug costs during the coverage gap phase, commonly referred to as the "doughnut hole.” Subsequent legislation, including the Affordable Care Act, “closed” the doughnut hole from the perspective of beneficiaries, largely through the creation of a manufacturer discount program.
Starting in 2025, the donut hole is gone, replaced with an annual $2,000 cap for out-of-pocket spending on prescription drugs. 2. You'll be able to pay for prescriptions over time
In the years since Medicare's creation in 1965, the role of prescription drugs in patient care has significantly increased. As new and expensive drugs have come into use, patients, particularly senior citizens at whom Medicare was targeted, have found prescriptions harder to afford. The MMA was designed to address this problem.
The new clampdown, in CMS’s 1,327-page final rule for Medicare in 2025, states that it aims to “ensure that agent and broker compensation reflect only the legitimate activities required by ...
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