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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.

Capitation

A payment based on the individual (for a set period of time) rather than a per-service payment. Insurance plans tend to pay a physician network…