By the end of 2024, the Medicare Part D coverage gap - known as the donut hole - will disappear forever. But until December 31, 2024, millions of seniors still face it. If you’re taking expensive medications and hit that gap, your out-of-pocket costs can spike overnight. You’re not alone. In 2022, nearly 1 in 4 Medicare Part D enrollees reached the coverage gap. For some, that meant paying $1,000 or more a month just to keep taking their drugs.
What the Donut Hole Actually Means in 2024
The donut hole isn’t a mystery. It’s a phase in your Medicare drug plan where you pay more for prescriptions after you and your plan have spent a certain amount on covered drugs. In 2024, that threshold is $5,030 in total drug costs. Once you hit that number, you enter the coverage gap. You don’t lose coverage - you just pay more.Here’s how it breaks down:
- During the donut hole, you pay 25% of the cost for both brand-name and generic drugs.
- For brand-name drugs, the manufacturer gives you a 70% discount, but that discount doesn’t count toward getting you out of the gap.
- Your plan pays 5% of the brand-name drug cost.
- For generics, your plan pays 75%, and you pay 25% - no manufacturer discount applies.
The real kicker? You don’t get out of the donut hole until your total out-of-pocket spending hits $8,000. That includes your 25%, your plan’s share, and the manufacturer discount. But here’s the catch: if you’re on a brand-name drug like Humira or Repatha, you’ll hit that $8,000 mark faster because the manufacturer discount counts toward it. If you’re on generics, you’ll spend way more out of pocket before you reach catastrophic coverage.
Why the Donut Hole Hits Hard - Real Stories
People don’t just talk about the donut hole - they live it.A Reddit user shared how their parent with rheumatoid arthritis was paying $1,200 a month for Humira during the gap. They had to skip doses. Another person on a Medicare forum split pills to make their medication last longer. A 74-year-old woman with high cholesterol had to choose between her statin and her insulin because she couldn’t afford both after entering the gap.
These aren’t rare cases. In a survey of 1,247 Medicare beneficiaries who hit the donut hole, 68% said they changed how they took their meds. One in three skipped doses. One in five cut pills in half. That’s not just cost-saving - it’s dangerous.
How to Lower Your Costs Before the Donut Hole Hits
You don’t have to wait until you’re in the gap to act. Start now.Check your plan’s formulary. Not all drugs are treated the same. Tier 1 drugs (usually generics) cost less. Tier 3 or 4 (brand-name or specialty drugs) cost more. If your drug is on Tier 4, you’re already on the path to the gap. Ask your pharmacist: “Is there a similar drug on a lower tier?”
Switch to generics. If your doctor says it’s safe, switching from a brand-name drug to its generic version can save you $1,200 to $2,500 a year. For example, switching from brand-name Lipitor to atorvastatin can drop your monthly cost from $150 to under $10. Many doctors assume patients know this - they don’t. Ask.
Use 90-day supplies. Many plans offer lower copays for 90-day mail-order prescriptions. You might pay $25 for a 90-day supply instead of $45 for three 30-day fills. That’s 20% savings. And if you’re approaching the gap, getting your 90-day supply early can help you stretch your spending across the year.
Apply for Extra Help. If your income is below $21,590 (individual) or $29,170 (couple) in 2024, you may qualify for the Low-Income Subsidy. It covers your deductible, reduces your copays, and eliminates the donut hole entirely. Over 12 million people qualified in 2023 - but only about half applied. Don’t assume you don’t qualify. Apply at SSA.gov or call 1-800-MEDICARE.
Use Manufacturer Discounts - They’re Real
Big drug companies offer patient assistance programs. These aren’t ads. They’re real savings.For example, Amgen’s program for Repatha (a cholesterol drug) reduced one woman’s monthly cost from $560 to $5 during the donut hole. Eli Lilly’s program for Humira cut costs by 85% for eligible users. These programs often require paperwork - a doctor’s note, proof of income, a prescription - but they’re free to apply for.
Go to the drugmaker’s website and search for “patient assistance program.” Or use NeedyMeds.org or RxAssist.org. Both are nonprofit and free. You can even call the manufacturer directly. Many have reps who walk you through the process.
Use the Medicare Plan Finder - Before It’s Too Late
Your plan changes every year. So should your strategy.The Medicare Plan Finder tool lets you enter your exact drugs, dosages, and pharmacy. It shows you which plan will cost you the least for the year - including how much you’ll pay if you hit the donut hole. In 2023, 14.3 million people used it. Those who optimized their plan saved an average of $1,047.
Don’t wait until open enrollment. Run your drugs through the tool now. If your current plan puts you at high risk for the gap, you might switch to a different plan during the Annual Enrollment Period (October 15-December 7). Some plans have lower initial coverage limits - meaning you hit the gap later. Others have better discounts on your specific drugs.
Spread Out Your Purchases - Strategically
If you’re close to the $5,030 threshold and still have meds to buy, you can delay entering the gap.For example: if you have $4,800 in spending so far and need $300 more to hit the gap, don’t refill your prescription right away. Wait until January. You’ll avoid the gap this year and start fresh in 2025.
But be careful. This only works if your meds aren’t life-critical. If you’re on insulin, blood thinners, or heart meds, don’t delay. Your health comes first. This trick is for non-urgent prescriptions - like allergy meds, osteoporosis drugs, or certain antidepressants.
What’s Changing in 2025 - And Why It Matters
Starting January 1, 2025, the donut hole is gone. Forever.The new rule: you pay no more than $2,000 out of pocket for all your Part D drugs in a year. After that, your plan covers 100% of costs. No more 25% coinsurance. No more $8,000 threshold. No more confusion.
Manufacturers will still give discounts - but now they’ll pay 10% during initial coverage and 20% after you hit the $2,000 cap. Your plan will cover the rest. This is a huge win.
But here’s the catch: premiums might rise slightly for some. The Medicare Payment Advisory Commission predicts average Part D premiums could go up 4.2% by 2026. That’s because manufacturers won’t be helping as much during the initial coverage phase anymore. But for most people - especially those on expensive drugs - the $2,000 cap will save hundreds or thousands.
What to Do Right Now
You have less than a month before the donut hole disappears. Here’s your checklist:- Log into Medicare.gov and run your drugs through the Plan Finder tool.
- Call your pharmacy and ask: “What’s my total drug spending so far this year?”
- If you’re close to $5,030, ask your doctor: “Can I switch to a generic?”
- Check if your drugmaker has a patient assistance program - even if you think you earn too much.
- Apply for Extra Help if your income is under $21,590 (individual) or $29,170 (couple).
- Review your 2024 Annual Notice of Change - mailed in September - to see how your plan is changing for 2025.
The donut hole has been a financial trap for years. But in 2025, it’s over. The real challenge now is making sure you don’t get caught in the last year of it. Don’t wait until you’re paying $1,000 a month for a single pill. Act now - before the gap closes for good.
Elizabeth Ganak
December 28, 2025 AT 04:44Just switched my dad from brand-name Lipitor to atorvastatin last month-his copay dropped from $140 to $8. We didn’t even tell the doctor we were doing it. He just said ‘sure, if it’s the same thing.’ Turns out it is. Save your pennies, folks.
Nicola George
December 29, 2025 AT 07:28So let me get this straight-you’re telling me a 74-year-old woman had to choose between insulin and cholesterol meds? And we’re still letting this happen in 2024? Wow. Just wow. I’m not even mad. I’m just… disappointed.
Liz MENDOZA
December 30, 2025 AT 11:31This is the kind of post that makes me believe people still care. Thank you for laying it out so clearly. I’ve been helping my neighbor navigate this mess for months-she didn’t even know about Extra Help. Just applied for her yesterday. She cried. I cried. We’re okay now.
Janice Holmes
December 31, 2025 AT 11:02THE DONUT HOLE IS A CORPORATE CONSTRUCT DESIGNED TO EXTRACT MAXIMUM PROFIT FROM THE ELDERLY WHILE MASKING IT AS ‘COST-SHARING.’ THE MANUFACTURER DISCOUNTS? A GIFT TO THE STOCKHOLDERS. THE $8,000 THRESHOLD? A TORTURE CHAMBER BUILT BY PHARMA LOBBYISTS. 2025 WON’T FIX IT-IT’LL JUST MAKE IT MORE SILENT.
Gerald Tardif
December 31, 2025 AT 20:57I used to think ‘patient assistance programs’ were just marketing fluff. Then my sister got on Humira. We spent three weeks filling out forms, got a letter back saying she qualified. Her monthly bill went from $1,100 to $12. No joke. It’s not magic-it’s paperwork. And it’s worth every minute.
Robyn Hays
January 1, 2026 AT 11:49Have you ever tried calling a drug company’s patient support line? They’re surprisingly nice. Like, weirdly nice. One rep spent 40 minutes helping me find a generic alternative for my mom’s antidepressant. She even emailed me a printable checklist. I cried. Again. Why are these people so good at their jobs?
John Barron
January 2, 2026 AT 12:34⚠️ WARNING: THE 2025 $2,000 CAP IS A TRAP. THEY’RE INCREASING PREMIUMS TO OFFSET THE LOSS. YOU’LL PAY MORE MONTHLY, BUT FEEL GOOD ABOUT ‘SAVING’ ON OUT-OF-POCKET. IT’S A PSYCHOLOGICAL GIFT WRAP. DON’T BE FOOLED. I’VE DONE THE MATH. IT’S A SLOW ROAST.
Will Neitzer
January 3, 2026 AT 21:37It is imperative to note that the structural inequities embedded within the Medicare Part D framework have historically disproportionately affected low-income seniors residing in rural communities, where access to pharmacies is limited and pharmaceutical literacy is often suboptimal. The application process for Extra Help, while nominally accessible, remains fraught with bureaucratic opacity, thereby perpetuating systemic disenfranchisement. A policy intervention grounded in equity, not merely cost containment, is not only advisable-it is morally exigent.
Olivia Goolsby
January 5, 2026 AT 15:43Did you know the donut hole was created in 2003 by a bill signed by George W. Bush… right after he approved a $500 billion tax cut for the top 1%? It’s not a glitch-it’s a feature. The same people who own the drug companies also own the politicians. The ‘gap’? It’s a funnel. And we’re all falling into it. 2025? They’ll just rename it ‘The New Normal.’
Raushan Richardson
January 5, 2026 AT 19:56My aunt just got her 90-day supply of metformin through mail order and saved $60. She’s 82. She didn’t even know this was an option. She’s now telling everyone at bingo. We need more of this. Not more laws-more sharing.
Alex Lopez
January 7, 2026 AT 09:02Let’s be real-the real hero here is NeedyMeds.org. Not the government. Not the drug companies. That site is like the internet’s version of a grandma who knows where all the free food is. Bookmark it. Print it. Tape it to your fridge.
Liz Tanner
January 8, 2026 AT 14:55I used to skip my blood pressure med every other day to make it last. I didn’t tell anyone. I was too ashamed. Reading this made me realize I wasn’t alone. I called my doctor yesterday. We switched me to a generic. I’m not skipping anymore. Thank you.
Anna Weitz
January 8, 2026 AT 17:18Why do we keep pretending this is about healthcare when it’s clearly about profit margins and shareholder dividends? The donut hole isn’t a policy flaw-it’s the entire business model. And 2025? They’ll just tweak the numbers and call it reform. We’re not fixing the system. We’re just giving it a new coat of paint.
Monika Naumann
January 9, 2026 AT 11:00It is deeply regrettable that such a profound societal responsibility as pharmaceutical access has been delegated to the whims of private enterprise. In nations where healthcare is recognized as a fundamental human right, such disparities do not exist. One must question the moral compass of a society that permits its elderly to choose between life-sustaining medications and basic sustenance.
Kishor Raibole
January 11, 2026 AT 04:20One must contemplate, with the gravity befitting a constitutional scholar, whether the so-called ‘donut hole’ is not, in fact, a metaphor for the hollowing-out of the American social contract. The patient assistance programs? Merely Band-Aids on arterial hemorrhages. The Medicare Plan Finder? A labyrinthine oracle designed to confuse rather than enlighten. The year 2025 shall not bring salvation-it shall bring a new taxonomy of exploitation, dressed in the language of progress.