An increased payment under Medicare’s prospective payment system or under Medicaid for hospitals that serve a large share of low-income uninsured patients. The Affordable Care Act (ACA) reduced DSH allotments under the assumption that many formerly uninsured...
Also known as “donut hole.” Coverage gap in Medicare Part D prescription drug coverage, as originally enacted, where enrolled beneficiaries paid 100 percent of their prescription drug costs after their total drug spending exceeded an initial coverage limit...
Most drug benefit plans classify drugs on a formulary into groups called “tiers” and establish different levels of cost-sharing for each tier. Lower tiers may have a fixed dollar copayment, but higher tiers increasingly use a percentage of drug cost to determine a...
A Medicare beneficiary who also receives either a full range of Medicaid benefits offered in his or her state, or help with Medicare out-of-pocket expenses. (Also see Medicare Savings Programs, Qualified Medicare Beneficiary and Specified Low-Income Medicare...