US Medical Term · pharmacy
Coverage Gap
Brecha de Cobertura
In 9 languages
| Language | Term |
|---|---|
| English | Coverage Gap |
| Spanish (Español) | Brecha de Cobertura |
| Chinese (中文) | 覆盖缺口（甜甜圈漏洞） |
| Korean (한국어) | 보장 공백 |
| Vietnamese (Tiếng Việt) | Khoảng trống bảo hiểm |
| Filipino (Tagalog) | Agwat sa Saklaw |
| Portuguese (Português) | Lacuna de Cobertura |
| Thai (ภาษาไทย) | ช่องว่างความคุ้มครอง |
| Japanese (日本語) | 給付ギャップ |
What it means
The coverage gap—informally known as the 'donut hole'—is a phase of Medicare Part D prescription drug coverage where you temporarily face higher drug costs. It begins after you and your plan together have spent a set total amount on covered drugs in a year. Until 2024, beneficiaries in the gap paid a larger share of drug costs; starting in 2025, the Inflation Reduction Act largely closes the donut hole by capping Medicare beneficiaries' annual out-of-pocket drug costs. After reaching the catastrophic coverage threshold, Medicare pays a very high percentage of costs. Generic drugs are typically cheaper during the gap phase. Copay assistance cards from drug manufacturers generally cannot be used by Medicare beneficiaries to fill this gap.
How to say it
Sentences a patient might use with a doctor, nurse, pharmacist, or insurer:
My Medicare drug plan entered the coverage gap in October, so my copay went up.
Mi plan de medicamentos de Medicare entró en la brecha de cobertura en octubre, así que mi copago subió.
The Inflation Reduction Act is helping close the Medicare coverage gap starting in 2025.
La Ley de Reducción de la Inflación está ayudando a cerrar la brecha de cobertura de Medicare a partir de 2025.
Ask your pharmacist if switching to a generic drug can lower your cost in the coverage gap.
Pregúntele a su farmacéutico si cambiar a un medicamento genérico puede bajar su costo en la brecha de cobertura.
Where you'll see it
Related terms
Sources
Last reviewed: September 2026