GOOD NEWS! …. The “Donut Hole” is going away – The new Rx total annual out-of-pocket is $2,000
There will be a lot of changes for 2025 and some changes you may not like. It is due to the Inflation Reduction Act.
As I understand it, this new Act is a progressive 3 year phase in. Bottomline, the insurance companies have explained that CMS (the government) is providing less money (or subsidies) to the insurance companies to operate their insurance plans. So, that get passed on to the members in the form of reducing benefits and may increase premiums and copays, etc.
The GOOD NEWS is that the “Donut Hole” is going away (that $8,000 max out of pocket for Rx). The total annual out of pocket for prescriptions for 2025 will now be $2,000. Insulin will be no more than a $35 copay per 30 days.