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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.
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 ...
Eliminating the donut hole. Previously, when a person with Medicare Part D coverage reached a certain amount of out-of-pocket costs, they would enter the coverage gap, or donut hole. While in the ...
The donut hole is closed, but that doesn't mean there's not a coverage gap. ... State Health Insurance Assistance Programs can help you navigate the complexities of Medicare and Medicare Advantage ...
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. [24]