AHIP Practice Exam 2025 - Free AHIP Practice Questions and Study Guide

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What is the coverage gap in Medicare Part D commonly referred to as?

The "doughnut hole"

The coverage gap in Medicare Part D is commonly referred to as the "doughnut hole." This term specifically describes the phase in the Part D benefit structure where beneficiaries experience a temporary limit on what the drug plan will cover for prescription medications. After reaching an initial coverage limit, beneficiaries enter this gap where they may have to pay a higher percentage of their drug costs out-of-pocket until they reach catastrophic coverage.

Understanding this terminology is important for beneficiaries as it helps them navigate their prescription drug benefits and anticipate potential costs they may incur during the coverage gap. The name "doughnut hole" reflects the concept of a gap in coverage, which is visualized as a hole in a doughnut, where the doughnut represents the total coverage offered by the plan.

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The "coverage plateau"

The "Medicare gap"

The "coverage gap"

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