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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 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. 5 big changes to Medicare 2025 plans you should know ...
While this coverage gap does not affect the majority of program participants, about 25% of beneficiaries enrolled in standard plans find themselves in this gap. [61] As a candidate, Barack Obama proposed "closing the 'doughnut hole'" and subsequently proposed a plan to reduce costs for recipients from 100% to 50% of these expenses. [62]
Coverage gap: The coverage gap is the phase that occurs after an individual and their drug plan have covered a certain amount. The coverage gap, or the donut hole, means that there is a temporary ...
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]
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