Medicare Part D Coverage Gap
Is the Part D Coverage Gap (Donut Hole) Going Away?
Yes. In previous years, you faced a coverage gap when you and your health plan spent a certain amount on your medications ($5,030 in 2024). After that you were required to pay 25% of your prescription drug costs until you reached an $8,000 annual out-of-pocket limit. Starting January 1, 2025, you will not pay anything for covered medications after you reach a $2,000 annual out-of-pocket limit.
Plus, the new rules make it easier to manage your out-of-pocket prescription drug costs. You can enroll in the new Medicare Prescription Payment Plan designed for members with high out-of-pocket prescription drug costs. This will let you make monthly payments versus paying the entire amount upfront. Participation in this program is completely optional. You will receive enrollment instructions from your health plan or give us a call if you have questions.
These changes also apply to Medicare Advantage plans that include prescription drug (Part D) coverage.
Anthem does not offer standalone Part D plans in the state of New York.
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Anthem, a Medicare Advantage organization with a Medicare Contract, offers HMO, HMO D-SNP, and LPPO plans. Anthem HMO D-SNP plans additionally contract with state Medicaid programs. Anthem Blue Cross and Blue Shield Retiree Solutions, a Medicare Organization with a Medicare Contract in New York, offers LPPO plans. Anthem Blue Cross Retiree Solutions, a Medicare Organization with a Medicare Contract in New York, offers LPPO plans. Enrollment in Anthem Blue Cross and Blue Shield, Anthem Blue Cross and Blue Shield Retiree Solutions, and Anthem Blue Cross Retiree Solutions plans depend on contract renewal.