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The donut hole limited how much insurance providers contributed to drug costs, increasing out-of-pocket costs. When an individual’s spending reached $8,000, it triggered “catastrophic coverage.”
Starting on January 1st, a new approach to Medicare Part D will remove the infamous “donut hole” and establish a new hard limit of $2,000 per year for out-of-pocket Part D drug spending.
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.
Medicare is big business, recently providing healthcare coverage to 68 million people. Before the 2024 election, fully 94% of surveyed seniors said it was very or extremely important to protect ...
Medicare Part D, also called the Medicare prescription drug benefit, is an optional United States federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs. [1]
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]
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 ...
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.
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