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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.
Coverage gap: The coverage gap is the phase that occurs after an individual and their drug plan have covered a certain amount. The coverage gap, or the donut hole, means that there is a temporary ...
This Coverage Gap phase is commonly referred to as "the Donut Hole." Beginning with the Affordable Care Act , cost-sharing in the Coverage Gap phase has been gradually reduced. Despite no longer triggering elevated cost-sharing, the Coverage Gap phase continues to exist for other administrative purposes.
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.
2.6 million were in the "coverage gap" due to the 19 states that chose not to expand the Medicaid program under the ACA/Obamacare, meaning their income was above the Medicaid eligibility limit but below the threshold for subsidies on the ACA exchanges (~44% to 100% of the federal poverty level or FPL); 5.4 million were undocumented immigrants;
Both plans offer healthcare coverage but differ greatly when it comes to accessing care. Learn how they work and about benefits and drawbacks when comparing your coverage choices.
These programs were known as "Medicare+Choice" or "Part C" plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the compensation and business practices for insurers that offer these plans changed, and "Medicare+Choice" plans became known as "Medicare Advantage" (MA) plans.
A big enticement of Medicare Advantage plans is that they typically include coverage for benefits not included in traditional Medicare, such as Medicare drug coverage (Part D), eyeglasses, dental ...
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