Checks aimed at helping fill the Medicare “donut hole” coverage gap that forces recipients to pay the full cost for prescription drugs
WASHINGTON, DC— In a conference call today, U.S. Senator Bob Casey (D-PA), a member of the Senate Health, Education, Labor and Pensions Committee, highlighted the $250 checks that are in the mail to help older Pennsylvanians pay for prescription drugs. The checks, part of the new health care reform law, address the so-called “donut hole” that forces some Medicare prescription drug coverage recipients to experience a gap in coverage and pay for their prescription drugs out of their own pocket.
“The Medicare prescription drug coverage gap isn’t a donut hole; it is a chasm that can create a nightmare for older citizens,” said Senator Casey. “The new health care law provides immediate help this year to help pay for Medicare prescription drugs.”
The Affordable Care Act provides Medicare beneficiaries who do not receive Medicare Extra Help, a program that helps beneficiaries with limited income pay for prescription drugs, with a $250 rebate check when they enter the “donut hole.” The first of these checks was mailed to beneficiaries on June 10 and checks will continue to go out monthly as beneficiaries enter the coverage gap.
In 2009, 188,749 beneficiaries in Pennsylvania fell into the Medicare prescription drug coverage gap. In 2010, the standard Part D benefit plan has a coverage gap of $3,610, beginning when an individual hits $2,830 in out-of-pocket spending and continuing until they incur $6,440 in total costs.
Senator Casey was joined on the call by Caya Lewis, Chief of Staff for the Centers for Medicare and Medicaid Services, Estella Hyde, State President for the AARP in Pennsylvania and Dick Chevrefils, the AARP Pennsylvania State Director.
The $250 checks are a first step to closing the Medicare prescription drug coverage gap by 2020. Next year, the effort continues when most beneficiaries will receive a 50 percent discount on brand-name drugs and biologics they purchase when they fall into the coverage gap.
The $250 rebate check is tax-free and older citizens do not need to do anything to receive it; Medicare will automatically mail a check. Medicare recipients with questions about the program can call 1-800-MEDICARE (1-800-633-4227). Unfortunately, there have been reports of people trying to commit fraud and take advantage of older citizens. To report fraud call 1-800-HHS-TIPS (1-800-447-8477).
The Medicare prescription drug benefit, or Part D, was created in 2003 in the Medicare Prescription Drug, Improvement and Modernization Act. The Republican-controlled Congress designed the program with a substantial gap in coverage in order to reduce costs of the program. Beneficiaries are required to continue paying premiums for the program even when they are in the coverage gap and not receiving assistance.
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