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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 ...
"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.
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 ...
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.
This Coverage Gap phase is commonly referred to as "the Donut Hole." Beginning with the Affordable Care Act , cost-sharing in the Coverage Gap phase has been gradually reduced. Despite no longer triggering elevated cost-sharing, the Coverage Gap phase continues to exist for other administrative purposes.
Individuals affected by the Medicare Part D coverage gap will receive a $250 rebate, and 50% of the gap will be eliminated in 2011. [36] The gap will be eliminated by 2020. Insurers' abilities to enforce annual spending caps will be restricted, and completely prohibited by 2014. [4] Insurers are prohibited from dropping policyholders when they ...
Coverage gap. Once you and your plan have spent $5,030 (in 2024) on covered drugs, including your deductible, you enter the "donut hole," where you'll pay 25% of the drug's cost . Catastrophic ...
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]