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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.
"Because of the prescription drug law, the coverage gap ends on Dec. 31, 2024," its website states. The so-called "donut hole," or coverage gap, has affected almost all prescription plans.
$2,000 out-of-pocket max and end of coverage ‘donut hole’ ... At the start of 2025, the Medicare Coverage Gap Discount Program will end. This program helps cover the cost of prescription drugs ...
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.
By the end of the century, less than one-third of drug spending was paid out-of-pocket. Despite the absence of a Medicare drug benefit, about 70% of Medicare enrollees obtained drug coverage through other means, often through an employer or Medicaid. [36] Medicare began offering subsidized outpatient drug coverage in the mid-2000s.
Coverage is available only through insurance companies and HMOs, and is voluntary. Enrollees paid the following initial costs for the initial benefits: a minimum monthly premium of $24.80 (premiums may vary), a $180 to $265 annual deductible, 25% (or approximate flat copay) of full drug costs up to $2,400.
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