Are You in the Doughnut Hole?

About 300,000 Massachusetts seniors may face the dreaded “doughnut hole” in 2010. Are you – or a family member – already in the hole?

Starting in June, seniors in Medicare who have reached the prescription drug coverage gap will automatically receive $250 rebate checks to help with their drug costs and other expenses, as part of the new health care reform law.

The U.S. Department of Health and Human Services (HHS) plans to begin mailing the first group of Medicare prescription drug rebate checks on June 10, 2010. Checks will continue to be mailed throughout the year as more people reach the doughnut hole.

Making Medicine More Affordable

“These rebate checks are the first step to gradually close the Medicare prescription drug doughnut hole – and help make prescription drugs more affordable for people in Medicare,” says Deborah Banda, AARP Massachusetts state director.

Research shows that people who have trouble paying for their prescription drugs are more likely to skip doses or stop taking their medications altogether. This can lead to more serious health problems and higher long-term costs both for them and the health care system as a whole.

A First Step

AARP Massachusetts member Patricia Liberti has fallen into the Medicare prescription drug doughnut hole repeatedly. Each year, once hitting the coverage gap, she has spent thousands of dollars to pay for the medicine that keeps her healthy and out of more expensive care. “The rebate check is definitely a step in the right direction,” Liberti says. “It’s $250 I didn’t have before. And, next year, I’ll have even more help, when I can get a good discount on brand name prescriptions.”

Closing the Gap

Starting in 2011, people who reach the Medicare prescription drug doughnut hole will receive a 50 percent discount on all brand name and biologic drugs, and a seven percent discount on generics. Over 10 years, more discounts will be applied for both brand and generic drugs until the coverage gap completely closes in 2020.

What You Need to Know

Five facts that people in Medicare should know about the rebate check and their prescription drugs:
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