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Medicare Drug Coverage Gap or “Donut Hole”

A gap in coverage where the beneficiary pays 100% of drug costs up to a limit, created by Medicare Part D legislation. Affordable Care Act addresses this by offering rebate checks for participants who reach their coverage gap and by requiring pharmaceutical companies to offer discounts to consumers.

Annual Coverage Limits

Limits on the dollar amount of treatment an individual can receive in a year, imposed by insurance providers. The ACA outlawed dollar based limits but…