How to Manage Medication Costs During Medicare Part D Coverage Gaps in 2024 (Before the Donut Hole Ends)

By the end of 2024, the Medicare Part D coverage gap-commonly called the donut hole-will disappear for good. But until January 1, 2025, millions of seniors are still stuck in a confusing, expensive phase where they pay more out of pocket for prescriptions. If you’re taking regular medications and your total drug spending hits $5,030 in 2024, you enter the donut hole. That’s not a rumor. It’s the current rule. And if you don’t know how to manage it, you could end up paying hundreds or even thousands more than you should.

What the Donut Hole Actually Means in 2024

The donut hole isn’t a loophole. It’s a phase in your Medicare Part D plan where your insurance stops paying most of your drug costs. You’ve already paid your deductible (up to $590 in 2025), and your plan covered drugs up to $5,030 in total drug costs (including what you paid and what your plan paid). Now, you’re on your own-sort of.

Here’s the catch: you still pay 25% of the cost for both brand-name and generic drugs. But that’s only part of the story. For brand-name drugs, the manufacturer gives you a 70% discount. That discount counts toward getting you out of the donut hole. For generics, there’s no manufacturer discount. So if you’re on Humira, Enbrel, or Repatha, you’re getting help from the drugmaker. If you’re on metformin or lisinopril, you’re not.

This means two people on the same plan, taking different drugs, can have wildly different out-of-pocket costs. One person might spend $3,300 to get out of the gap. Another might spend $6,000. That’s not a typo. That’s how the math works.

Why This Matters More Than You Think

In 2022, nearly 1 in 5 Medicare Part D enrollees hit the donut hole. That’s over 10 million people. And according to the Medicare Rights Center, 68% of those people said they changed how they took their meds because of cost. Some skipped doses. Others split pills. One Reddit user, a Medicare counselor with 12 years of experience, shared a story about a client paying $1,200 a month for Humira during the gap-forcing them to choose between medicine and groceries.

It’s not just about cash. It’s about health. Skipping insulin? Not an option. Skipping blood pressure meds? That leads to ER visits, hospital stays, and higher costs down the road. The Medicare Payment Advisory Commission found that eliminating the donut hole could reduce prescription abandonment by 18-22%, saving the system $1.2 billion a year in avoided care.

How to Slash Your Costs Before the Donut Hole Ends

You don’t have to wait for 2025 to save money. Here’s what actually works right now.

• Check your drug’s tier. Your plan puts drugs into tiers. Tier 1 is cheapest. Tier 3 or 4? That’s where the donut hole hits hardest. If your drug is on Tier 3, you’re paying 25% coinsurance until you hit $5,030. Ask your pharmacist or log into your plan’s website. If your drug is on a higher tier, ask your doctor if a lower-tier alternative exists.
• Switch to generics. If you’re on a brand-name drug like Eliquis or Lyrica, ask if a generic is available. GoodRx found that switching to generics can save $1,200 to $2,500 a year. For example, switching from brand-name Adderall to generic amphetamine salts can cut your monthly cost from $200 to under $30.
• Use manufacturer assistance programs. Big drug companies have patient programs. Amgen’s program for Repatha cut one user’s cost from $560 to $5 a month during the gap. AbbVie helps with Humira. Merck helps with Januvia. Go to the drugmaker’s website and search for “patient assistance.” You’ll need your prescription and income info. Many are free.
• Get 90-day supplies. Mail-order pharmacies often charge less for 90-day fills. Medicare.gov says you can save 15-25% on copays. If you take a drug daily, this is an easy win. Some plans even waive the deductible for mail-order orders.
• Apply for Extra Help. If your income is under $21,870 (single) or $29,580 (married), you qualify for the Low-Income Subsidy. It covers your deductible, lowers your copays, and eliminates the donut hole entirely. In 2023, 12.6 million people got it. You might be one of them and not know it.

Use the Medicare Plan Finder-Now

Your plan changes every year. Just because you stayed with the same one last year doesn’t mean it’s still the best. The Medicare Plan Finder tool lets you type in your exact drugs and see how much each plan will cost you in 2024. The National Council on Aging found that people who use this tool save an average of $1,047 a year.

Don’t just pick the cheapest premium. Pick the plan that’s cheapest for your meds. A plan with a $30 monthly premium might charge $150 for your insulin. Another with a $60 premium might charge $25. That’s a $1,500 difference over the year.

Spread Out Your Purchases (Carefully)

If you’re close to hitting the $5,030 threshold, you can delay entering the donut hole by spreading your fills across different pharmacies. Buy your first 30-day supply at CVS, the next at Walgreens, the next at your local independent pharmacy. This spreads your spending across multiple pharmacies, so you don’t hit the cap as early.

But be careful. This only works if your plan tracks all your spending across pharmacies. Most do now. If you’re unsure, call your plan. Don’t risk getting hit with a surprise bill because you thought you were avoiding the gap.

What’s Changing in 2025 (And Why You Should Care)

Starting January 1, 2025, the donut hole is gone. Forever. You’ll pay no more than $2,000 out of pocket for all your Part D drugs in a year. After that, your plan covers everything. No more 25% coinsurance. No more manufacturer discounts counting toward your cap. No more confusion.

But there’s a twist. The $2,000 cap is only for what you pay. It doesn’t include what your plan pays or what manufacturers pay. So if you’re on a $1,000-a-month drug, your plan might still pay $500 of it. That’s fine. You only care about your out-of-pocket.

Experts warn that premiums might rise slightly for some people-especially lower-income beneficiaries who used to benefit from manufacturer discounts counting toward catastrophic coverage. But for most, the change is a win. The average annual savings for those who hit the gap in 2022 is estimated at $980. That’s like getting a free prescription every few months.

What to Do Right Now

You have less than a month before the donut hole disappears. Here’s your checklist:

1. Log into your Medicare account and check your 2024 drug spending. Go to Medicare.gov and use the Plan Finder.
2. Call your pharmacist. Ask: “Am I close to the $5,030 threshold?”
3. Check if your drugs have generics or lower-cost alternatives.
4. Visit the manufacturer’s website for your drugs. Look for “patient assistance” or “copay card.”
5. Apply for Extra Help if your income is under $21,870 (single) or $29,580 (married).
6. Review your 2025 Annual Notice of Change. It arrived in September. Don’t ignore it.

The donut hole was designed as a cost-control tool. But it became a trap for seniors. The fix is coming. But until then, you don’t have to suffer. You have tools. You have options. Use them.