BETA
The infamous coverage gap
Historically, once patients spent a certain amount on drugs, they entered a gap where they paid high out-of-pocket costs. The Affordable Care Act and subsequent 2022 Inflation Reduction Act systematically capped and phased out these high expenses.
Chapter 1
The birth of Original Medicare
Chapter 2
The rise of Medicare Advantage
Chapter 3
The battle of choices and prescriptions
Ch 3 · The battle of choices and prescriptions
hank Sort health benefits into each plan to discover how Medicare and Medicare Advantage differ.
hank Medicare vs Medicare Advantage
Original Medicare, government-backed, you choose your own doctor. But Advantage plans bundle extra care, and cap your yearly spending.
hank Medicare Advantage choices vary widely by geography, with urban areas offering dozens of plans while rural areas have very few.
Fun Fact
Drug cost cap: Starting in 2025, federal law capped annual out-of-pocket prescription drug costs at $2,000 for all Medicare Part D enrollees.
hank The donut hole was a temporary limit on what drug plans would pay, which was closed by federal legislation.
Glossary
part d (noun)
An optional federal program that helps Medicare beneficiaries pay for outpatient prescription drugs. In 2006, the federal government launched this benefit, forcing seniors to select standalone or bundled private plans.
An optional federal program that helps Medicare beneficiaries pay for outpatient prescription drugs. In 2006, the federal government launched this benefit, forcing seniors to select standalone or bundled private plans.
Quiz
Which law capped Medicare Part D out-of-pocket drug costs at $2,000 starting in 2025?