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The donut hole will disappear after 2024 and be replaced by a new $2,000 out-of-pocket cap in 2025. This change, due to the Inflation Reduction Act, affects all Medicare plans.
Officially, Medicare drug plans no longer have a donut hole—the gap between covered drugs and catastrophic coverage. This hole was gradually closed thanks to provisions in the Affordable Care ...
Major changes in 2025 include Medicare Advantage plans and a new $2,000 out-of-pocket max under Part D, eliminating "donut hole" coverage gap.
Prior to 2010, enrollees were required to pay 100% of their retail drug costs during the coverage gap phase, commonly referred to as the "doughnut hole.” Subsequent legislation, including the Affordable Care Act, “closed” the doughnut hole from the perspective of beneficiaries, largely through the creation of a manufacturer discount program.
In 2024, the donut hole occurs when a person and their plan have spent more than $5,030 on covered medications. Once spending reaches this figure, a person will pay for brand-name drugs but at no ...
The Medicare Part D coverage gap (informally known as the Medicare donut hole) was a period of consumer payments for prescription medication costs that lay between the initial coverage limit and the catastrophic coverage threshold when the consumer was a member of a Medicare Part D prescription-drug program administered by the United States federal government.
The "donut hole" provision of the Patient Protection and Affordable Care Act of 2010 was an attempt to correct the issue. [23] In 2022, the Inflation Reduction Act removed this ban and allowed Medicare to begin negotiating drug prices starting in 2026. [24]
Image source: Getty Images. Here are six changes in the offing for Medicare in 2025. 1. Say goodbye to the "donut hole" If you know a little about Medicare, you might be familiar with the "donut ...
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