Archive: If my current prescription drug retail cost are $230 per month, what will be my cost or discount in the Donut Hole?

If you reach your Medicare Part D plan's Donut Hole, you will receive a 75% discount on all formulary drugs (generics and brand-name drugs).

However, if your retail drug costs are about $230 per month, you probably will never reach your plan's Donut Hole.

In fact, if your total monthly retail medication costs are under $420, you will not exceed the standard 2024 Initial Coverage Limit (ICL) of $5,030 and will not enter the 2024 Donut Hole - and you will not need the Donut Hole Discount.

If your total retail prescription costs exceed $420 a month in 2024, then you will exceed the Initial Coverage Limit for your plan and will enter the Donut Hole.

You can read more in our article: Understanding the 2024 Medicare Part D Donut Hole

Please note, a few Medicare Advantage plans that include drug coverage (MAPD) offer a lower or higher Initial Coverage Limit instead of the standard $5,030. Please refer to your plan's coverage information (or Evidence of Coverage mailing) for more details.

If your medications costs exceed your plan's Initial Coverage Limit and you enter the Donut Hole in 2024, you will get a 75% discount on generic medication covered by your Medicare Part D prescription drug plan (you pay 25% of retail) and a 75% discount on any brand-name medications covered by your plan (you pay 25% of retail). Important Fact: 2024 is the last year that the Donut Hole will exist.

In 2025 one of the provisions of the Inflation Reduction Act (IRA) of 2022 is the elimination of the Coverage Gap (Donut Hole). Medicare Part D beneficiaries will stay in the Initial Coverage phase until they reach the maximum cap on out-of-pocket spending for Part D formulary drugs - RxMOOP - which is set at $2,000 for 2025. After reaching RxMOOP Medicare Part D beneficiaries will have a $0 copay for all formulary drugs.