Medicare, the US government’s health insurance program for seniors and the disabled, is a complex system navigating its intricacies can be daunting. This guide unravels the complexities of Medicare, from eligibility requirements and coverage details to enrollment processes and appeals. Understanding the nuances of Parts A, B, C, and D is crucial for beneficiaries to maximize their benefits and avoid costly mistakes.
We’ll explore the various components of this vital program, offering clarity and insight into its often-confusing aspects.
From the initial enrollment period to navigating the complexities of Medicare Advantage plans and prescription drug coverage, we provide a practical roadmap for beneficiaries to confidently manage their healthcare needs. We’ll delve into the financial aspects, including premiums, deductibles, and cost-sharing, equipping readers with the knowledge to make informed decisions about their healthcare. We’ll also address common concerns, such as appealing Medicare decisions and protecting against fraud.
Medicare Part B
Medicare Part B, the medical insurance portion of the program, is a crucial component for seniors and those with qualifying disabilities seeking outpatient care. It helps cover a wide range of services, but understanding its nuances is key to maximizing its benefits and managing costs. This section details the coverage, costs, and provider network associated with Medicare Part B.
Services Covered Under Medicare Part B
Medicare Part B covers a broad spectrum of medically necessary services. This includes physician services, outpatient hospital care, certain home healthcare services, and many preventive services. Specific examples include doctor visits, tests conducted in a doctor’s office or outpatient facility (such as blood tests and X-rays), mental healthcare, and some physical and occupational therapy. However, it’s crucial to note that Part B doesn’t cover every medical expense.
Coverage details and limitations are Artikeld in the Medicare Part B Summary of Benefits. Beneficiaries should always check their coverage before receiving services to avoid unexpected costs.
Monthly Premium Costs for Medicare Part B
The monthly premium for Medicare Part B varies depending on an individual’s income. For 2023, the standard monthly premium was $164.90. However, higher-income beneficiaries pay a higher premium, with the amount increasing incrementally based on income brackets. The Centers for Medicare & Medicaid Services (CMS) website provides detailed information on the income-related monthly adjustment amount (IRMAA) for Part B premiums.
These adjustments are based on an individual’s modified adjusted gross income (MAGI) reported two years prior. For example, a beneficiary with a significantly higher income might pay a premium exceeding $500 per month. It is essential to consult the CMS website or a Medicare representative for the most up-to-date and personalized premium information.
Medical Providers Accepted by Medicare Part B
Medicare Part B accepts a wide range of healthcare providers, including physicians, hospitals (for outpatient services), and other healthcare professionals. Most doctors and healthcare facilities that accept Medicare assignment agree to accept the Medicare-approved amount as full payment for services. However, some providers may choose not to participate in Medicare, or they may opt out of Medicare assignment, meaning they can bill beneficiaries more than the Medicare-approved amount.
It’s advisable to verify a provider’s Medicare participation status before scheduling an appointment to avoid potential out-of-pocket expenses. Medicare’s online provider directory is a helpful resource for this purpose.
Comparison of Medicare Part B Supplemental Plans
Choosing a supplemental plan, often referred to as Medigap, can significantly impact out-of-pocket costs. Medigap plans help cover some of the gaps in Medicare Part B coverage, such as copayments, deductibles, and coinsurance. Different Medigap plans offer varying levels of coverage. The cost and benefits can vary significantly between plans and insurers.
| Medigap Plan | Monthly Premium (Example) | Coverage Highlights |
|---|---|---|
| Plan G | $150 (Example) | Covers Part B deductibles, copayments, and coinsurance. Does not cover Part B premium. |
| Plan F | $200 (Example) | Covers Part B deductibles, copayments, and coinsurance. Also covers Part B premium (Note: New enrollment in Plan F is generally not allowed for those turning 65 after 2020). |
| Plan N | $100 (Example) | Covers Part B coinsurance. Has a small copayment at the doctor’s office and for some other services. Does not cover Part B deductible. |
Note: The premium examples above are illustrative and will vary depending on location, insurer, and individual circumstances. It is crucial to obtain current quotes from multiple insurers before selecting a Medigap plan. These examples do not represent all available Medigap plans.
Medicare Part C
Medicare Part C, also known as Medicare Advantage, offers an alternative to Original Medicare (Parts A and B). While Original Medicare provides coverage through a fee-for-service model, Medicare Advantage plans are offered by private companies that have contracts with Medicare to provide all Part A and Part B benefits, and often additional benefits such as vision, dental, and hearing coverage.
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Choosing between Original Medicare and Medicare Advantage depends heavily on individual needs and preferences, including budget, health status, and geographic location.
Medicare Advantage Plans Compared to Original Medicare
Medicare Advantage plans and Original Medicare differ significantly in their structure and cost. Original Medicare involves paying deductibles and coinsurance for services, with the beneficiary choosing their own doctors and hospitals. Medicare Advantage plans, on the other hand, typically involve a monthly premium (in addition to the Part B premium), and often have lower out-of-pocket costs for in-network care.
However, access to out-of-network providers is generally restricted, unlike Original Medicare. The choice hinges on balancing cost predictability and flexibility in healthcare provider selection. A crucial difference is the annual enrollment period for Medicare Advantage, which is more limited than the opportunities to switch between Original Medicare and supplemental plans.
Types of Medicare Advantage Plans
Medicare Advantage plans are offered in various formats, each with its own network of providers and cost-sharing structures. HMO (Health Maintenance Organization) plans generally require beneficiaries to choose a primary care physician (PCP) who manages their care and referrals to specialists. PPO (Preferred Provider Organization) plans offer more flexibility, allowing beneficiaries to see specialists without a referral, although out-of-pocket costs are typically higher for out-of-network care.
Other types include POS (Point of Service) plans, which combine elements of HMO and PPO plans, and Special Needs Plans (SNPs), designed for specific populations such as those with chronic conditions or those residing in specific geographic areas. The choice of plan type directly impacts the level of flexibility and cost associated with healthcare access.
Coverage Limitations of Medicare Advantage Plans
While Medicare Advantage plans often include additional benefits beyond Original Medicare, they also have limitations. Network restrictions are a primary concern, limiting access to specialists or providers outside the plan’s network. Prior authorization may be required for certain services, creating potential delays in care. Benefits can vary significantly between plans, and some plans may have stricter rules regarding coverage for specific procedures or treatments.
Beneficiaries should carefully review the plan’s formulary (list of covered drugs) and benefit details before enrollment. For example, a plan might cover a specific brand-name medication but not a generic equivalent, leading to higher out-of-pocket costs.
Medicare Advantage Plan Enrollment
Enrollment in a Medicare Advantage plan occurs during the Annual Enrollment Period (AEP), typically running from October 15th to December 7th, with coverage beginning January 1st of the following year. Individuals can also enroll during a Special Enrollment Period (SEP) if they experience certain qualifying life events, such as moving to a new area or losing other health coverage.
The enrollment process involves comparing plans based on factors such as premiums, deductibles, copayments, and network providers. Medicare.gov provides a comprehensive online tool to compare plans based on individual needs and location. Careful consideration of the plan’s coverage details, including the formulary and provider network, is crucial to avoid unexpected out-of-pocket expenses or limitations in access to care.
Consulting with a Medicare advisor can assist in navigating the enrollment process and choosing the most appropriate plan.
Medicare Part D
Medicare Part D is the prescription drug insurance plan offered to Medicare beneficiaries. It helps cover the costs of prescription medications, but the specifics of coverage vary depending on the plan chosen and individual circumstances. Understanding the nuances of Part D is crucial for seniors to manage their healthcare expenses effectively.
Medicare Part D Coverage
Medicare Part D plans are offered by private companies that Medicare has approved. These plans help pay for prescription drugs. The level of coverage depends on the specific plan selected, with different plans offering various premiums, deductibles, and copayments. Beneficiaries typically pay a monthly premium for their Part D coverage, in addition to any other Medicare premiums. Once the annual deductible is met, the plan begins to cover a percentage of the cost of medications.
However, the extent of coverage isn’t unlimited; a coverage gap, commonly known as the “donut hole,” exists.
The Medicare Part D Coverage Gap (Donut Hole)
The Part D coverage gap, or donut hole, is a phase where beneficiaries pay a higher percentage of their prescription drug costs. This gap exists between the initial coverage limit and the catastrophic coverage threshold. The donut hole’s existence reflects the tiered structure of Part D coverage. There are three phases:
- Initial Coverage: This is the phase where the beneficiary pays their deductible and co-pays as determined by their plan. Once the total out-of-pocket expenses reach a certain amount (the initial coverage limit), the beneficiary enters the coverage gap.
- Coverage Gap: In this phase, the beneficiary pays 25% of the cost of their medications. The manufacturer provides a discount on brand-name drugs, reducing the patient’s out-of-pocket expenses during this period. The length of this phase depends on the total cost of the beneficiary’s prescription drugs.
- Catastrophic Coverage: Once the beneficiary’s total out-of-pocket expenses reach a certain level (the catastrophic coverage threshold), Medicare Part D pays a larger share of the costs of their medications. The patient’s cost-sharing becomes significantly lower, providing significant relief.
Commonly Covered Prescription Drugs Under Part D
A wide range of prescription drugs are typically covered under Part D, including medications for chronic conditions such as diabetes, high blood pressure, and high cholesterol. Common examples include insulin, statins, and blood pressure medications. However, the specific drugs covered and the level of coverage vary by plan. It is important to check the formulary (list of covered drugs) for each plan before selecting one.
The formulary also specifies the tier (cost-sharing level) for each drug, influencing the patient’s out-of-pocket costs.
Obtaining Prescription Medications Through Medicare Part D: A Flowchart
The process of obtaining prescription medications through Medicare Part D can be visualized as follows:A flowchart would be depicted here, illustrating the following steps:
1. Choose a Part D plan
Compare plans based on cost, formulary, and other factors.
2. Enroll in a Part D plan
Complete the enrollment process through Medicare.gov or a private insurance provider.
3. Obtain a prescription from a doctor
Receive a prescription for the needed medication.
4. Fill the prescription at a participating pharmacy
Use your Part D card at a pharmacy in the plan’s network.
5. Pay co-pay or cost-share
The amount paid depends on the drug’s tier and the plan’s coverage.
6. Track your out-of-pocket expenses
Monitor expenses to understand progress towards the coverage gap and catastrophic coverage.
Medicare Premiums and Costs
Navigating the complexities of Medicare often involves understanding the associated costs. Premiums, deductibles, and co-pays can vary significantly, influenced by a range of factors impacting the overall financial burden on beneficiaries. This section details the key drivers of Medicare premium costs and provides resources for cost estimation.
Factors Influencing Medicare Premium Costs
Several key factors determine the cost of Medicare premiums. The most significant is the beneficiary’s income. Higher earners generally pay more for their Part B and Part D coverage. The standard monthly Part B premium is set annually by the Centers for Medicare & Medicaid Services (CMS) and can change based on factors such as the projected cost of healthcare services and the number of enrolled beneficiaries.
Additionally, the cost of prescription drugs significantly influences Part D premiums, fluctuating based on drug pricing and the specific plan chosen. Finally, the type of Medicare coverage selected (Part B, Part C, or Part D) directly impacts premium costs, with Medicare Advantage (Part C) plans often offering varying premium structures depending on the plan’s benefits and network.
Income’s Impact on Medicare Premiums
Medicare Part B premiums are income-related for most beneficiaries. Individuals with higher incomes pay higher premiums than those with lower incomes. The income considered is the beneficiary’s modified adjusted gross income (MAGI) from two years prior. For example, the MAGI reported on your 2022 tax return will be used to determine your 2024 Medicare Part B premium.
CMS publishes income brackets and corresponding premiums annually. Those with incomes above a certain threshold pay a higher premium, reflecting a progressive cost-sharing structure. This system aims to ensure those with greater financial capacity contribute a larger share towards the program’s costs. Failure to accurately report income can lead to penalties.
Resources for Estimating Medicare Costs
Several resources help individuals estimate their Medicare costs. The official Medicare website (medicare.gov) provides a premium calculator that allows users to input their income and other relevant information to receive a personalized estimate. Additionally, the Social Security Administration website offers information regarding Medicare premiums and provides guidance on the income-related adjustments. Independent insurance brokers specializing in Medicare can also assist with personalized cost projections, helping beneficiaries compare different plan options and understand their out-of-pocket expenses.
These brokers can analyze an individual’s specific needs and medical history to recommend the most cost-effective plan.
Medicare Premium Costs by Income Bracket (Illustrative Example)
The following table provides an illustrative example of how income brackets might correlate with Medicare Part B premiums. Note that these figures are for illustrative purposes only and are not reflective of current or future rates. Actual premiums vary annually and depend on several factors. Consult the official Medicare website for the most up-to-date information.
| Income Bracket (Annual MAGI) | Estimated Monthly Part B Premium |
|---|---|
| Under $88,000 | $164.90 |
| $88,000 – $110,000 | $225.00 |
| $110,000 – $130,000 | $285.00 |
| Over $130,000 | $345.00 |
Medicare Enrollment Process
Navigating the Medicare enrollment process can seem daunting, but understanding the timelines and steps involved simplifies the procedure. This section details the key aspects of enrolling in Medicare, including eligibility periods and potential penalties for delayed registration. Accurate and timely enrollment ensures access to the appropriate coverage and avoids unnecessary financial burdens.
Initial Enrollment Period
The Initial Enrollment Period (IEP) is the seven-month window you have to enroll in Medicare Part A and/or Part B. This period begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. Missing this window can result in significant penalties. For individuals who are already receiving Social Security retirement benefits, enrollment in Part A is usually automatic.
However, Part B requires separate enrollment. Those who are not yet receiving Social Security benefits must actively enroll during their IEP. Failure to do so necessitates a manual application and potential penalties.
Special Enrollment Periods
Several circumstances allow individuals to enroll in Medicare outside their IEP. These Special Enrollment Periods (SEP) provide opportunities to sign up if you missed your IEP or experience a qualifying life event. Examples of qualifying life events include job loss resulting in the termination of employer-sponsored health insurance and end-stage renal disease. Understanding these SEPs is crucial for individuals who need to enroll outside the standard timeframe.
Late Enrollment Penalties
Delaying Medicare Part B enrollment beyond your IEP or SEP can result in higher monthly premiums for as long as you have Part B coverage. The penalty is calculated based on how long you delayed enrollment and is a percentage increase applied to the standard premium. For example, a one-year delay might increase your monthly premium by 10%.
This penalty is permanent and is added to your regular premium. Similarly, delays in enrolling in Medicare Part D (prescription drug coverage) can lead to penalties, impacting the cost of prescription medications.
Step-by-Step Guide to Medicare Enrollment
Understanding the enrollment process is key to securing appropriate coverage. The following steps provide a clear pathway to successful enrollment:
- Determine your eligibility: Verify that you meet the age and residency requirements for Medicare.
- Gather necessary documents: Collect your Social Security number, driver’s license, and other identification documents as requested.
- Contact Social Security Administration (SSA): Apply for Medicare Part A and Part B during your IEP or SEP. You can apply online, by phone, or in person.
- Review Medicare Part B options: Choose a Medicare Advantage (Part C) plan or a Medigap (supplemental) policy to supplement your original Medicare coverage (Part A and Part B).
- Enroll in Medicare Part D: If you require prescription drug coverage, enroll in a Medicare Part D plan during your IEP or SEP.
- Review your plan choices: Carefully compare plans based on your needs and budget before making a final decision.
- Confirm your enrollment: After applying, receive confirmation of your enrollment and review your coverage details.
Appealing Medicare Decisions
Navigating the Medicare system can be complex, and beneficiaries may sometimes disagree with coverage decisions. Understanding the appeals process is crucial to ensuring access to necessary healthcare services. This section Artikels the steps involved in appealing a Medicare decision, the various levels of appeal, and the resources available to assist beneficiaries.
The Medicare Appeals Process
Medicare offers a multi-step appeals process designed to provide beneficiaries with a fair and thorough review of coverage denials or other disputed decisions. The process begins with a reconsideration, followed by progressively higher levels of review if necessary. Each level allows for the submission of additional evidence to support the appeal. The specific timeframe for each level varies, but beneficiaries should act promptly to protect their rights.
Levels of Medicare Appeals
The Medicare appeals process generally consists of four levels: Reconsideration, Hearing before an Administrative Law Judge (ALJ), Review by the Appeals Council, and Judicial Review.Reconsideration involves a review of the initial decision by a different Medicare contractor. This level typically focuses on a review of the evidence already submitted. A Hearing before an ALJ offers a more formal setting, including the opportunity to present evidence and testimony.
The Appeals Council reviews ALJ decisions, focusing on whether the ALJ followed proper procedures and applied the correct rules. Finally, Judicial Review allows beneficiaries to challenge the Appeals Council’s decision in federal court. This is a final recourse, usually only pursued if significant legal issues are involved.
Resources and Contact Information
Beneficiaries can find detailed information about the appeals process on the Centers for Medicare & Medicaid Services (CMS) website. CMS provides comprehensive guides, fact sheets, and frequently asked questions. The website also includes contact information for local Medicare contractors who can provide assistance with navigating the appeals process. Furthermore, State Health Insurance Assistance Programs (SHIPs) offer free, unbiased counseling and assistance to Medicare beneficiaries, including help with appeals.
SHIP counselors can provide personalized guidance and support throughout the process.
Appealing a Medicare Decision: A Flowchart
The following describes a simplified flowchart illustrating the Medicare appeals process:[Imagine a flowchart here. The flowchart would begin with a box labeled “Medicare Coverage Decision.” Arrows would branch from this box to two boxes: “Agree with Decision” and “Disagree with Decision.” The “Disagree with Decision” box would lead to a box labeled “Request Reconsideration.” From this box, arrows would lead to two more boxes: “Reconsideration Decision Favourable” and “Reconsideration Decision Unfavourable.” The “Reconsideration Decision Unfavourable” box would lead to a box labeled “Request Hearing Before ALJ.” This would continue in a similar manner, showing the progression through the Hearing before an ALJ, Review by the Appeals Council, and finally, Judicial Review.
Each box would ideally include a brief description of the stage.]
Medicare and Supplemental Insurance (Medigap)
Medigap, also known as Medicare Supplement Insurance, plays a crucial role in filling the gaps in Medicare coverage. Because Medicare doesn’t cover all healthcare expenses, Medigap policies help offset out-of-pocket costs such as deductibles, copayments, and coinsurance. These policies are sold by private insurance companies, and their availability and specific benefits vary by state and insurer. Understanding the nuances of Medigap is essential for beneficiaries seeking comprehensive healthcare financial protection.
Medigap Plan Types and Coverage
Ten standardized Medigap plans (A through N) exist, each offering a specific set of benefits. These plans are designed to supplement Original Medicare (Parts A and B), not Medicare Advantage (Part C). The plans are standardized within each state, meaning a Plan G in one state offers the same benefits as a Plan G in another. However, the cost of premiums can vary significantly based on factors such as age, location, and the insurer.
Crucially, Medigap plans do not cover everything. They generally don’t cover vision, hearing, or dental, and prescription drug coverage is handled separately through Medicare Part D or a stand-alone prescription drug plan.
Medigap Plan Costs and Benefits Comparison
The cost of a Medigap plan depends on several factors, including the plan type, the insurer, the beneficiary’s age, and location. Generally, plans offering more comprehensive coverage have higher premiums. For example, Plan F (which covers most out-of-pocket costs) typically has higher premiums than Plan G (which has a similar benefit structure but requires beneficiaries to pay Part B deductibles).
Beneficiaries should carefully weigh the increased premium costs against the potential savings on out-of-pocket expenses. A thorough cost-benefit analysis, considering individual healthcare utilization patterns, is essential for choosing the right plan.
Comparison of Popular Medigap Plans
The following table compares key features of several popular Medigap plans. Note that this is not an exhaustive list, and specific benefits and costs can vary by insurer and location. It’s crucial to contact insurance providers directly for the most up-to-date information.
| Plan | Part A Coinsurance | Part B Coinsurance | Part B Deductible | Foreign Travel Emergency Care | At-Home Recovery Care |
|---|---|---|---|---|---|
| Plan G | Yes | Yes | No | Yes | No |
| Plan F | Yes | Yes | Yes | Yes | No |
| Plan N | Yes | Yes (with a copay) | No | Yes | No |
| Plan K | Yes | Yes (with a copay) | No | Yes | No |
Medicare Fraud and Abuse
Medicare fraud and abuse represent a significant financial and ethical challenge to the U.S. healthcare system. These illegal activities drain billions of dollars annually from the Medicare Trust Fund, ultimately impacting the quality and accessibility of care for beneficiaries. Understanding the various forms of fraud, their consequences, and reporting mechanisms is crucial for protecting the integrity of the program.
Types of Medicare Fraud and Abuse
Medicare fraud and abuse encompass a wide range of deceptive practices. These schemes often involve complex networks of individuals and organizations, making detection and prosecution challenging. The financial stakes are substantial, motivating perpetrators to employ sophisticated methods to avoid detection.
| Type of Fraud | Description | Reporting Method |
|---|---|---|
| Billing for services not rendered | Providers submitting claims for services that were never provided to beneficiaries. This can include billing for procedures that were not performed, or for visits that did not occur. Often involves falsifying medical records. | Contact the CMS at 1-800-MEDICARE (1-800-633-4227) or report online at the CMS website. Alternatively, report to the FBI or the Office of Inspector General (OIG). |
| Upcoding | Billing for a more expensive service than the one actually provided. For example, billing for a complex procedure when a simpler, less expensive procedure was performed. This inflates the reimbursement received by the provider. | Contact the CMS at 1-800-MEDICARE (1-800-633-4227) or report online at the CMS website. Alternatively, report to the FBI or the OIG. |
| False claims | Submitting fraudulent claims to Medicare, including falsifying documentation or making false statements to obtain payment. This can involve creating false identities or using stolen identities to submit claims. | Contact the CMS at 1-800-MEDICARE (1-800-633-4227) or report online at the CMS website. Alternatively, report to the FBI or the OIG. |
| Kickbacks and bribery | Offering or receiving payments in exchange for referrals or other actions related to Medicare billing. This can involve paying physicians or other healthcare providers to refer patients to a particular facility or service. | Contact the CMS at 1-800-MEDICARE (1-800-633-4227) or report online at the CMS website. Alternatively, report to the FBI or the OIG. |
| Identity theft | Using a beneficiary’s personal information (Social Security number, Medicare number) to submit fraudulent claims without their knowledge or consent. | Contact the CMS at 1-800-MEDICARE (1-800-633-4227) or report online at the CMS website. Report to the Federal Trade Commission (FTC) and the Social Security Administration (SSA) as well. |
Consequences of Medicare Fraud and Abuse
The consequences of Medicare fraud and abuse are severe, encompassing significant financial penalties, imprisonment, and reputational damage. Individuals and organizations found guilty face substantial fines, and criminal convictions can lead to lengthy prison sentences. Beyond the legal ramifications, convictions can result in exclusion from participation in federal healthcare programs, effectively ending a provider’s career. Furthermore, the reputational damage can be irreparable, severely impacting the trust placed in the healthcare provider.
For example, the False Claims Act allows for treble damages (three times the amount of the fraud) plus civil penalties.
Reporting Suspected Medicare Fraud and Abuse
Reporting suspected Medicare fraud and abuse is a critical step in protecting the program and its beneficiaries. Several avenues exist for reporting such activities, offering various levels of anonymity and protection for whistleblowers. The Centers for Medicare & Medicaid Services (CMS) provides multiple channels for reporting, including a dedicated hotline and online reporting forms. The Federal Bureau of Investigation (FBI) and the Office of Inspector General (OIG) also actively investigate Medicare fraud and are key resources for reporting suspected illegal activity.
Whistleblowers who report fraud are often protected under laws like the False Claims Act, which provides financial incentives for successful prosecutions.
Successfully navigating the Medicare system requires careful planning and a thorough understanding of its various components. This guide has provided a comprehensive overview of Medicare’s key features, equipping readers with the knowledge to make informed choices and access the benefits they deserve. From understanding eligibility criteria and coverage details to mastering the enrollment process and handling appeals, this resource serves as a valuable tool for individuals seeking to optimize their Medicare experience.
Remember to regularly review your coverage and stay informed about any changes to ensure you receive the best possible care.
Commonly Asked Questions
What is the difference between Medicare Part A and Part B?
Part A covers hospital insurance (inpatient care), while Part B covers medical insurance (outpatient care, doctor visits).
When can I enroll in Medicare?
Most people enroll during their Initial Enrollment Period (IEP), which begins three months before their 65th birthday and ends three months after.
What is Medigap insurance?
Medigap supplements Original Medicare (Parts A and B), helping to cover out-of-pocket costs like deductibles and co-pays.
How can I report Medicare fraud?
Report suspected fraud to the Centers for Medicare & Medicaid Services (CMS) or the Department of Health and Human Services (HHS).
What is the Medicare donut hole?
The “donut hole” refers to the coverage gap in Medicare Part D prescription drug coverage where beneficiaries pay a higher percentage of their prescription drug costs.
