Medicare part D has shrunk the donut but it still affects cost.
For 2023 it’s like this.
Deductible: If you’re enrolled in a Medicare prescription drug plan, you may have to pay up to the first $505 of your drug costs, depending on your plan.5 This is known as the deductible. Some plans don’t have a deductible, or have a smaller deductible, but no Part D plan can have a deductible in excess of this amount.
Initial coverage level: During the initial coverage phase (after the deductible is met, assuming the plan has a deductible), you pay a copayment or coinsurance, and your Part D drug plan pays its share for each covered drug until your combined amount (including your deductible) reaches $4,660.3
Entering the donut hole: Once you and your Part D drug plan have spent $4,660 for covered drugs, you will be in the donut hole. Prior to 2011, you would have had to pay the full cost of your prescription drugs at this point. But now that the ACA has closed the donut hole, you’ll pay 25% of the cost of your drugs while in the donut hole. Again, the donut hole is “closed” because 25% of the cost is the same as what you’d pay in the initial coverage level with a standard plan design. But since most plans don’t have standard designs, it’s very likely that 25% of the cost of your drugs (while you’re in the donut hole) is going to amount to more than you were paying before you entered the donut hole.
Leaving the donut hole: The donut hole continues until your total out-of-pocket cost reaches $7,400 in 2023 (a significant increase from the $5,100 threshold that was applicable in 2019).6 This annual out-of-pocket spending amount includes your yearly deductible, copayment, and coinsurance amounts, and it also includes the manufacturer’s discount on the drugs that you get while in the coverage gap. This means that although you only pay 25% of the cost of your medications while in the donut hole, 95% of the cost of your brand-name drugs will be counted towards getting you to the $7,400 level where you’ll get out of the donut hole and enter the catastrophic coverage level. But for generic drugs, only the 25% that you pay will count towards getting your spending to that $7,400 level where you’ll leave the donut hole, since there’s no manufacturer discount for those drugs.
I have not checked 2024 yet...I think the deductible is $525
Donut Hole is supposed to go away in 2025.