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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.
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.
Medicare part D plans have four parts: the deductible stage, initial coverage, the coverage gap, and catastrophic coverage. Each part resets every year. Each part resets every year.
It is the base amount allowed for premiums. The Centers for Medicare & Medicaid Services (CMS) ... At the start of 2025, the Medicare Coverage Gap Discount Program will end. This program helps ...
The amount of cost-sharing an enrollee pays depends on the retail cost of the filled drug, the rules of their plan, and whether they are eligible for additional Federal income-based subsidies. 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.”
The coverage gap is the phase that occurs after a person and their plan cover a certain amount of drug costs. Out-of-pocket maximum: The maximum amount a person will pay out of pocket is $8,000 .
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