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Medicare Part D Doughnut Hole Rebate 101

These are fast paced, confusing times. But, AARP VI wants to make sure that VI seniors don’t get concerned when Medicare Part D rebate $250 checks start arriving in the mail next month.

There was originally talk about Congress passing a $250 rebate that would have been given to all seniors receiving Social Security checks. That measure did not pass, and this is an entirely new benefit for certain Medicare Part D beneficiaries.

The rebate checks going out in June are part of the Medicare Part D program, and not a Social Security Program adjustment intended to grant seniors a Cost of Living Allowance (COLA) increase. Seniors will not be receiving any additional money from the Social Security Administration related to the cost of living.    

Instead, checks will be mailed to certain Medicare beneficiaries. There are several criteria to keep in mind.

First, rebate checks are limited only to those individuals who are on a Medicare Part D plan in the Virgin Islands, and who are paying their own premiums and co-pays each month.

This is important to distinguish because there are many people benefiting from the Medicare Part D program, but some people are accessing it through enrollment in a public assistance program such as the State Pharmaceutical Assistance Program (SPAP) or Medicaid. These programs pay for the premiums, co-pays and medications on behalf of the enrollee and the enrollee pays very little or nothing at all out-of-pocket. Therefore, no reimbursement check will be issued to beneficiaries of public assistance programs because they are already receiving maximum assistance from the government and the rebate was intended to provide financial relief to those persons who were not already benefiting from government help.

So, this means that not all Medicare Part D beneficiaries will automatically receive a rebate check.

Next, rebate checks will only be mailed to those who have fallen into the doughnut hole during the first quarter of 2010. If you fell into the doughnut hole after April 1st, you should expect your check later this year.

Please remember that the rebate check is a one-time benefit. Regardless of the amount of money you pay for your prescriptions while in the doughnut hole, you will only receive one $250 rebate check.

And finally, there are a lot of scams floating out there. AARP VI does not want any Virgin Islander to become a victim of these inappropriate activities. If you have fallen into the doughnut hole, the only thing that you need to do is save your receipts. Your Virgin Islands Medicare Part D plan, either Community Care Rx (CCRx) or AARP, will have the records of all transactions related to your prescription purchases. You do not have to do anything! There is no one to call, write, or email and there is absolutely no form for you to fill out. The process is automatic for those who, as explained above, qualify for a rebate.

If you have questions, call the State Health Insurance Program (SHIP) offices located within each of the two territorial hospitals. VI SHIP can be reached at (340) 772-7368 in the St. Croix district and (340) 714-4354 in the St. Thomas/St. John district.

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