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Some major changes in 2025 include a new $2,000 out-of-pocket max under Part D, eliminating the plan’s “donut hole” coverage gap, and fewer Medicare Advantage plans.
Say goodbye to the "donut hole" gap in coverage. ... when your insurance coverage then resumed. ... Medicare pays. 4. Mental health coverage has expanded.
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 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 ...
After the initial coverage limit is met, a period commonly referred to as the "Donut Hole" begins when an enrollee may be responsible for the insurance company's negotiated price of the drug, less than the retail price without insurance.
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.
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