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Catastrophic coverage begins after a person meets their maximum out-of-pocket expenses of $6,550 (in 2021) and starts to pay less for prescription drugs.
The out-of-pocket cost cap could be a "game changer" for many seniors, Ryan Ramsey, the associate director of health coverage and benefits at the National Council on Aging (NCOA) told CBS MoneyWatch.
Prior to 2010, the standard benefit included a Coverage Gap phase in which, after accruing significant spending, relatively-high cost enrollees were required to pay a 100% coinsurance amount until they entered the Catastrophic phase. This Coverage Gap phase is commonly referred to as "the Donut Hole." Beginning with the Affordable Care Act ...
(In 2023, once you hit catastrophic coverage, you still owed 5% of your drug costs.) ... Musick believes the $2,000 cap could even persuade some health insurers to stop offering Part D plans.
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.
High-deductible health plans are a form of catastrophic coverage, intended to cover for catastrophic illnesses. [2] Adoption rates of HDHPs have been growing since their inception in 2004, not only with increasing employer options, but also increasing government options. [ 3 ]
KFF, a nonpartisan health policy research organization, warns that some plans may adjust their premiums, formularies, copays or deductibles in response to the new $2,000 out-of-pocket spending cap.
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is a law passed by the U.S. Congress on a reconciliation basis and signed by President Ronald Reagan that, among other things, mandates an insurance program which gives some employees the ability to continue health insurance coverage after leaving employment.