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Out-of-pocket spending on covered prescriptions is now capped at $2,000 a year — the old “donut hole” is gone.

Medicare News · Part D & Drug Pricing

Out-of-pocket spending on covered prescriptions is now capped at $2,000 a year — the old “donut hole” is gone.

What changed

Starting in 2025 and continuing in 2026, Medicare caps what you pay out of pocket for covered Part D drugs at $2,000 for the year. Once you hit it, covered prescriptions cost you nothing for the rest of the year. The old coverage-gap “donut hole” no longer applies.

Who it affects

Anyone with high prescription costs on a Part D plan or a Medicare Advantage plan with drug coverage — especially people on specialty or brand-name drugs who used to hit the donut hole.

What to do

You don’t have to do anything to get the cap — it applies automatically. But it’s still worth a yearly plan review, because premiums and formularies change even with the cap in place. You can also spread costs monthly with the payment-plan option.

Learn more

Not sure what this means for you? Call us free at 435-219-5120 (TTY: 711) — no cost, no pressure. See more in the Medicare News center or the Help Center.

Sources

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