Exit the Medicare Donut Hole; Enter the $2,000 Cap

When first implemented in 2006, the Part D drug plan had a gap in coverage. Drug plans did not pay anything toward the cost of drugs in the donut hole so beneficiaries were stuck with the tab for the entire cost. Beginning in 2011, the Affordable Care Act (ACA) took measures to close the donut hole, known as the Coverage Gap. Then, in 2012, the ACA implemented discounts for the Coverage Gap. In 2019, discounts meant that beneficiaries paid 25% of the cost for any brand-name medication, officially closing the donut hole, and 37% for generics. Then, in 2020, the donut hole for generic drugs is also closed. Finally, the Inflation Reduction Act eliminated the donut hole as of January 1, 2025.

Now, drug plan members will pay no more than $2,000 out-of-pocket for covered prescription medications. Here are a few important points to know.

The cap will apply automatically; you do not have to do anything.
It applies only to covered medications, meaning those that are included in a plan’s formulary.
It does not apply to Part B or over-the-counter drugs.
The cap is starting at $2,000 but it will be indexed annually for inflation.

Our current Medicare Open Enrollment savings record:
$235,000

How much could you save by reviewing your coverage between Oct. 15 and Dec. 7?

Answer the following simple three questions. If you can answer yes to any of these questions, we strongly recommend reviewing your coverage during this year’s Open Enrollment Period:

1. Do your take any brand-name drugs?
2. Have you changed or added any medications and/or physicians in the past year?
3. Have you had the same Medicare plan for two or more years?

Remember, people who review their Medicare coverage often save hundreds of dollars or more on their Medicare coverage.

Learn more now!

What is the Medicare Donut Hole?

If you are not familiar with the Medicare Part D Coverage Gap (also known as the Medicare Donut Hole), it's time to learn about it. Get started with this fun infographic.

View the infographic

Sixty-Five Incorporated

Exit the Medicare Donut Hole; Enter the $2,000 Cap

Our current Medicare Open Enrollment savings record:$235,000

What is the Medicare Donut Hole?

Our current Medicare Open Enrollment savings record:
$235,000