06/07/2025
Good information, everyone. In 2024, the maximum out-of-pocket cost for Medicare Part D enrollees was capped at approximately $3,300 to $3,800 for those who have high drug costs and reach the catastrophic coverage phase. Once this cap is reached, enrollees are no longer responsible for 5% coinsurance for the remainder of the year. Starting in 2025, this cap will be reduced to $2,000, and the coverage gap (or "donut hole") will be eliminated. This cap includes deductibles, copayments, and coinsurance for covered drugs. Once a person's out-of-pocket spending reaches $2,000, their Part D plan pays 100% of the cost for covered drugs for the rest of the year. The cap does not cover costs for medications not covered by Part D, such as those covered under Part B (e.g., injectables) or medications purchased outside of the plan.
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