Doughnut hole meaning

Doughnut hole definitions

Doughnut Hole is a term used in healthcare referring to a coverage gap in Medicare prescription drug plans. This gap occurs when an individual reaches a certain spending threshold on prescription drugs, after which they become responsible for a higher percentage of the costs until they reach catastrophic coverage.

Many Medicare Part D plans have a standard benefit structure that includes the initial coverage phase, the coverage gap (doughnut hole), and catastrophic coverage. During the initial coverage phase, the individual pays a copayment or coinsurance for their prescription drugs until they reach a certain spending limit. Once this limit is reached, they enter the coverage gap phase.

Entering the Doughnut Hole

When an individual enters the doughnut hole, they are required to pay a higher percentage of the costs for their prescription drugs. In 2021, the coverage gap begins once total drug costs reach $4,130 and ends when out-of-pocket costs reach $6,550. During this phase, the individual is responsible for paying 25% of the costs for both brand-name and generic drugs.

Changes to the Doughnut Hole

Thanks to healthcare reform, the Affordable Care Act has made changes to the Medicare Part D coverage gap. The out-of-pocket spending limit for individuals in the coverage gap will continue to decrease each year until 2020 when the coverage gap will be completely closed.

Doughnut holes in healthcare coverage can be a financial burden for individuals, especially those with high prescription drug costs. Understanding how the coverage gap works and planning for these expenses can help individuals navigate this phase of their Medicare Part D plan.

Doughnut hole Examples

1. She always saves the doughnut hole for last as it's her favorite part.
2. The doughnut shop ran out of doughnut holes, much to the disappointment of the customers.
3. He accidentally dropped the doughnut hole on the floor, much to his dismay.
4. The baby happily munched on a sugary doughnut hole, making a mess in the process.
5. After finishing her doughnut, she offered the doughnut hole to her friend who gladly accepted it.
6. The baker perfected the recipe for his doughnut holes, resulting in a line out the door at his shop.
7. He tried to resist the temptation of the remaining doughnut hole, but eventually gave in and ate it.
8. As a special treat, the teacher brought in doughnut holes for her students to enjoy during class.
9. The doughnut hole had a gooey caramel filling that made it extra delicious.
10. She decided to share the last doughnut hole with her brother, even though she really wanted it for herself.

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