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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 ...
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 ...
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.
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.
What is the Medicare Part D donut hole? The term “donut hole” refers to a gap in coverage. In 2024, the donut hole occurs when a person and their plan have spent more than $5,030 on covered ...
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.
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]
Coverage gap (donut hole): Until 21st December 2024, Medicare Part D plans have a coverage gap or donut hole once Medicare and the individual spend $5,030 on drug costs. Once a person reaches the ...
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