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Medicare Donut Hole

Medical billing & coding glossary · all terms

Legacy term. The coverage-gap phase was eliminated from the standard Medicare Part D benefit in 2025; current benefits use deductible, initial-coverage, and catastrophic phases with an annual out-of-pocket threshold.

You may encounter Medicare Donut Hole in historical claims, policy documents, or archived records. Use the current equivalent above for present-day work, and verify payer guidance for the applicable date of service.

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