The 'Donut Hole' in Medicare

Dear Friends,

We hope you all had a wonderful holiday season as we begin a New Year and a new quarter century. By the end of this quarter century, it is projected that we will have more people in the United States over 65 (22%) than under 18 (20%). Obviously, services and benefits for this segment of the population will continue to be a priority for those of us who advocate for a quality of life and healthy aging for older adults.

We are starting this year with a very significant shift in Medicare benefits. For years, we have heard about the "donut hole" or coverage gap in Medicare Part D payment for prescriptions. Starting on January 1st, 2025, a provision in the Inflation Reduction Act eliminates the donut hole coverage gap and limits out-of-pocket prescription costs to people enrolled in Medicare Part D to $2,000 per year. This will result in tremendous cost savings for some of our most vulnerable older adults.

Historically, Medicare Part D was legislated through the Medicare Modernization Act of 2003 and enacted in 2006. Participants in Medicare Part A or B could sign up for this benefit at an additional monthly cost and receive their prescription drugs at a subsidized rate. There was a coverage gap built in called the "donut hole." This gap in coverage occurred annually after a certain amount of prescription expenses were paid at a subsidized rate. Once a person reached the gap, they paid 100% for all prescriptions up to a certain cap. When that was reached, the plan would again cover prescriptions at a reduced rate for the remainder of the year. The Affordable Care Act of 2010 included a gradual "closing" of the donut hole. But "closing" did not mean that people reaching the donut hole didn't pay anything for their drugs—it meant that plans and pharmaceutical companies picked up more of the tab. But, in fact, by 2020, people were paying more out-of-pocket than ever before, and the gap seemed to become bigger. When a person entered the donut hole, they would be responsible for paying 25% of the costs of their medications. Once they reached a certain threshold of spending, for example, $8,000 in 2024, they entered the catastrophic coverage period and would pay 5% of the cost for each prescription. Some people ended up paying more than $10,000 per year for their prescriptions.

The $2,000 cap per year for filling prescriptions is transformational. Money that had been spent on prescriptions by many of our vulnerable older adults can now be used for food, housing, or even taking medicines as prescribed rather than cutting back on them because they could not afford them.

Over the next quarter century, we hope to see many more reforms that will make healthcare more accessible and more age-friendly communities so that people can age with dignity and respect at their highest potential for health.

Have a great month!

Tara A. Cortes, PhD, RN, FAAN

T eaching Nursing Home Series

We are introducing The Teaching Nursing Home Series!

The Teaching Nursing Home Series prepares nursing home supervisory staff and nursing school faculty to develop academic-practice partnerships. This series describes how to create successful student clinical rotations in nursing homes that allow students to care for older adults with complex and overlapping illnesses. It helps to create strategies to ensure interaction with healthcare teams, as well as ensure a faculty/staff partnership that fosters the student’s appreciation of the complexity of care and enhances the staff's ability to effectively work with novice nurses.

This series includes the following courses:

Teaching Nursing Home Overview
Nursing Home Basics
Nursing Practice in Nursing Homes
Resident-Directed Care and Culture Change
Structuring Student Placements
Structuring Student Placements Case Study
Resident-Directed Care and Culture Change
Introducing Resident-Directed Care and Nursing Home Culture Change Case Study
Resources to Help Nursing Homes Prepare to be Clinical Sites for Nursing Students

A new book from Sigma Marketplace, Practice & Leadership in Nursing Homes, an excellent companion resource for The Teaching Nursing Home Series.

Are Your Interpreter Services Meeting the Needs — and

Legal Requirements — of Residents with Limited

English Proficiency?

Prof. Allison Squires, NYU Meyers, wrote a column for McKnight’s Long-Term Care news on how the quality of long-term care for older adults with limited English proficiency depends on how well interpreter services are integrated into an organization’s care delivery systems.

Click here to read the full column.

HIGN Highlights

Prof. Fidel Lim received the 2024 American Nurses Association NY Mentorship Award at the ANA-NY's annual conference. This is given to an exemplary mentor who, over the course of their career, consistently dedicates themselves to helping less experienced nurses.

Prof. Tina Sadarangani received a 2025 Technology Acceleration & Commercialization Award in the amount of $40,000 from NYU's Discovery Research Fund for her innovative app, CareMobi, which helps family and community-based caregivers track a loved one's health, medications, appointments, and health documents.

Prof. Tina Sadarangani was featured in the following media outlets as an expert source:

Patch. Rethinking H ow to Take Control of Your Health Care published on November 15, 2024.
First for Women. Balancing Big Kids and Aging Parents: A Caregiver’s Guide to Navigating the Sandwich Generation published on November 22, 2024.
Prevention Magazine. The 26 Best Gifts for People with Dementia, According to Caregivers published on November 30, 2024.
Fox News. 10 tips for dementia caregivers to make the holidays less stressful and more enjoyable published on December 20, 2024.
Our Ventura TV. Caregiving And Community published on November 11, 2024.

Prof. Bei Wu and Prof. Xiang Qi’s research assessing the association between age at Type 2 diabetes diagnosis and risk for later dementia was featured in the Drug Topics mag azine.

Publications:

Breder, K. & Bockting, W. "Examining LGBT Older Adult Social Networks and Chosen Families Using the Convoy Model of Social Relations." Journal of Family Theory & Review.

Breder, K., Jacob, C., & Yu, V. "Assessing Older Adults Who Have Experienced Homelessness: Findings from an Exploratory Study." Journal of Applied Gerontology.

Scherer, J.S., Gore, R.J., Georgia, A., Cohen, S.E., Caplin, N., Zhadanova, O., Chodosh, J., Charytan, D. & Brody, A.A. I mplementation of Ambulatory Kidney Supportive Care in a Safety Net Hospital. Journal of Pain and Symptom Management. DOI: 10.1016/j.jpainsymman.2024.12.025 (In Press).

Narges Razavian; Neil Jethani; Simon Jones; Nicholas Genes; Vincent J. Major; Ian S. Jaffe; Anthony B. Cardillo; Noah Heilenbach; Nadia Fazal Ali; Luke J. Bonanni; Andrew J. Clayburn; Zain Khera; Erica C. Sadler; Jaideep Prasad; Jamie Schlacter; Kevin Liu; Benjamin Silva; Sophie Montgomery; Eric J. Kim; Jacob Lester; Theodore M. Hill; Alba Avoricani; Ethan Chervonski; James Davydov; William Small; Eesha Chakravartty; Himanshu Grover; John Dodson; Abraham A. Brody; Yindalon Aphinyanaphongs (2024). Evaluating Large Language Models in Extracting Cognitive Exam Dates and Scores. PLOS Digital Health. 10.1371/journal.pdig.0000685 PMCID: PMC11634005

Keating, S.A., Emerson, E.A., Vetter, M.J. & Boyar, K. Integrating design thinking competencies into a community health nursing course: Creative problem solving around the Healthy People National 2030 Goals. Nursing Education Perspectives. (Accepted, 2024).

Carman, L., & Lim, F. (2024). Simulation-Based Learning About Care of People With Disabilities: An Integrative Review. Nurse Educator, 10-1097.

Murali, K.P., Carpenter, J.G., Kolanowski, A., Gilmore-Bykovskyi, A. (2025). Comprehensive Dementia Care Models: State of the Science and Future Directions. Research in Gerontological Nursing. (in press)

Chastain, A., Shang, J., Murali, K.P., King, L., Ogunlusi, C., Zhao, S., Kang, J.A., Zhao, Y., Dualeh, K., McDonald, M.V. (2024). Development and Testing of Novel Questionnaires Assessing Palliative Care-Related Knowledge, Attitudes, and Confidence Among Home Healthcare Clinicians, Patients, and Caregivers. Home Healthcare Now. (in press)

Murali, K. P., Ma, C., Harrison, K. L., Hunt, L. J., Rosa, W. E., & Boyden, J. Y. (2024). Palliative Nursing in Home Health Care Across the Lifespan. AJN The American Journal of Nursing, 124(12), 53-59. https://doi.org/10.1097/01.Naj.0001095240.11717.87

Sui, J., Wu, B., Zheng, Y., Mo, Z., Dong, Q., Ðoàn, L. N., ... & Qi, X. (2025). Racial and ethnic disparities in the burden of non-obese type 2 diabetes using different anthropometric measurements. Obesity Medicine, 53, 100573.

Ali, S. H., Nayak, A., Qi, X., Misra, S., & DiClemente, R. J. (2024). How do Asian American young adults influence the health of family members? Structural equation modeling of age, acculturation, interactivity, and closeness. Discover Social Science and Health, 4(1), 66.

Presentations:

Keating, S.A. (2024). Integrating design thinking competencies into a community health nursing course: Creative problem solving around the healthy people national 2030 objectives for older adults. 2024 National Hartford Center for Geriatric Nursing Excellence (NHCGNE) Annual Conference.

Murali, K.P., Burgdorf, J.G., Ma, C., Luth, E., Smith, J.M., Mroz, T.M. (2024). Innovating for equitable home healthcare: Reducing barriers to social and end-of-life care for older adults. Symposium Chair. Gerontological Society of America Annual Scientific Conference. Seattle, WA.

Murali, K.P., Wang, G., Vergez, S., McDonald, M.V., Schulman-Green, D., Brody, A.A., Bullock, K. (2024). Barriers to Hospice Care Transitions Among People with Dementia in Home Healthcare: Views of Diverse Care Partners. Gerontological Society of America Annual Scientific Conference. Seattle, WA.

Murali, K.P. (2024). Developing a Health Equity-Focused Hospice Transitions Care Management Intervention for People with Dementia and their Care Partners in Home Healthcare: Qualitative Findings. Care Managers Research Presentation Part 3. VNS Health, New York, NY.

Murali, K.P., Gills, J.L., Briggs, A.Q., Cesar, J.O., Kovbasyuk, Z., Valkanova, E., Mbah, A., Figueredo, L.F., Kam, K., Mullins, A.E., Parekh, A., Jean-Louis, G., Varga, A., Osorio, R., Bubu, O.M. (2024). Association of Sleep Duration and APOE ε4 Status on Brain Regional Tau Deposition in Clinically Normal Older Adults. SLEEP Conference. Houston, TX.