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Medicare Part D and Health Care Reform – Eliminating the Doughnut Hole
Health Care Reform, also known as the Affordable Care Act, provides several changes to health care benefits for seniors. One of these changes provides a fix to eliminate a 'doughnut' hole in the coverage of Medicare Part D, Medicare's prescription drug coverage that was passed in 2006.
Doughnut Hole Graph courtesy of the Center for American Progress
Under the current Medicare guidelines, when a senior goes over the $2,830 limit in prescription drug costs, there is no Medicare payment assistance available. Many senior citizens were taken by surprise by this coverage gap, and it became known as the 'doughnut hole' of Medicare Part D. After the $2,830 in total drug costs is reached, then the full cost of prescription drugs is paid by the Medicare recipient – at least until the out-of-pocket costs reach $4,550 ($6,400 total, when the drug plan begins to pay most of the costs of covered drugs).
For 2010, Health Care Reform is giving a $250 rebate to Medicare beneficiaries who fall into this coverage gap. In 2011, there will be a 50% discount on prescription drugs within the 'doughnut' hole. The legislation eliminates the gap by the year 2020, when coverage within this gap will be a more palatable copay of 25% of the drug costs.
How to Receive the Medicare "doughnut Hole" Rebate
If a senior citizen is eligible, how do he or she get a rebate check? Medicare will mail it automatically to eligible beneficiaries; there are no forms required. In fact, if anyone calls or requests personal information saying it is needed for a rebate, it is a scam. Rebate checks began to be distributed in July, 2010, and will continue monthly throughout the year as beneficiaries enter the coverage gap.
* You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:
1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week;
The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call, 1-800-325-0778; or Your State Medicaid Office
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