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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.
costs paid during the initial coverage phase. costs paid during the coverage gap. 95% of the cost of brand-name medications. Costs that do not help a person reach their catastrophic coverage limit ...
Insurance companies themselves, as well as self-insuring employers, purchase stop-loss coverage for a premium to protect themselves. [1] In the case of a participant reaching more than the specific (or "individual") stop-loss deductible ($300,000, for example), the insurer will reimburse the insured (the company, not the participant) for the remainder of the claim to be paid over that ...
The insurance payment is further reduced if the patient has a copay, deductible, or a coinsurance. If the patient in the previous example had a $5.00 copay, the physician would be paid $45.00 by the insurance company. The physician is then responsible for collecting the out-of-pocket expense from the patient. If the patient had a $500.00 ...
Costs for employer-paid health insurance are rising rapidly: between 2001 and 2007, premiums for family coverage have increased 78%, while wages have risen 19% and inflation has risen 17%, according to a 2007 study by the Kaiser Family Foundation. [74] Employer costs have risen noticeably per hour worked, and vary significantly.
A broad coalition is backing state legislation that would impose a first-in-the-nation cap on medical bills -- aimed at New York's hospitals that own or house outpatient clinics and charge higher ...
“Insurance premiums being charged in the state of Florida have skyrocketed over the last couple of years. Part of it is the reinsurance costs,” Florida State University professor and insurance ...
Academic health centers, which emphasize research, teaching, and new technologies, may be disadvantaged by the payment scheme. [59] Providers risk large losses, for example if a patient experiences a catastrophic event. [60] A complex "reinsurance mechanism" may be needed to convince providers to accept bundled payments. [60]