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No, according to Medicare. "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 ...
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 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.
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 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 Part D participants received a 50% discount on brand name drugs purchased after exhausting their initial coverage and before reaching the catastrophic-coverage threshold. [111] By 2020, the "doughnut hole" would be completely filled. [112]
In 2024, the donut hole occurs when a person and their plan have spent more than $5,030 on covered medications. Once spending reaches this figure, a person will pay for brand-name drugs but at no ...
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.
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