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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.
The ‘donut hole’ refers to the gap between a plan’s initial prescription medication coverage by co-payment or coinsurance and the time when a person meets catastrophic coverage limits where ...
"Because of the prescription drug law, the coverage gap ends on Dec. 31, 2024," its website states. The so-called "donut hole," or coverage gap, has affected almost all prescription plans.
This program helps cover the cost of prescription drugs for Part D beneficiaries who reach the donut hole. Since the donut hole is going away due to the new $2,000 out-of-pocket cap, the Coverage ...
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.
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.
Starting in 2025, out-of-pocket drug spending will be capped at $2,000 per year and the prescription drug “doughnut hole” will be eliminated. Here’s how the new system will work:
Before the hole closed, Medicare Part D beneficiaries were responsible for 100% of prescription drug costs once they reached their spending threshold, until hitting catastrophic coverage ...