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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. ... Expansion of mental health care & caregiver ...
The so-called "donut hole," or coverage gap, has affected almost all prescription plans. ... The cap will allow people "to make better decisions on how to get their health care," Ramsey noted ...
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.
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" 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]
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 Medicare Part D coverage gap (commonly called the "donut hole") will be completely phased out and hence closed. [151] The "Cadillac Tax" (originally scheduled to take effect on January 1, 2018) will go into effect. [152] (repealed in late 2019 before taking effect)