With the first checks going out this summer, Montanans in Medicare Part D who reach the prescription drug coverage gap (or “doughnut hole”) this year will automatically receive a rebate of $250 to help with their drug costs and other expenses. As part of the new health care law, the rebate check is the first step in the gradual closing of the doughnut hole, which will help make prescription drugs more affordable for people in Medicare Part D. Closing this gap has been a top priority for AARP members and all older Americans.
Last year, 33 percent of Montanans in Medicare fell into the doughnut hole coverage gap. Because increases in many brand name drugs prices have consistently outpaced inflation, the doughnut hole was growing ever larger—along with the number of people falling into this coverage gap. In fact, a recent study by the AARP Public Policy Institute estimates that an additional 38.9 percent of Montanans in Medicare are at risk of falling into the gap. That means more than 70 percent of Montanans with Medicare drug coverage are facing the full costs in the doughnut hole because they lose their Medicare Part D prescription drug coverage when they need it most.
Nationwide, more than 3 million people fall into the doughnut hole each year, and millions more live in fear of reaching this expensive gap in coverage. Research shows that people who have trouble paying for their prescription drugs are more likely to skip doses or stop taking their medications altogether, which can lead to more serious health problems and higher long-term costs both for them and for our health care system as a whole.
Starting in 2011, people who reach the doughnut hole will receive a 50 percent discount on brand-name drugs. By 2020, the doughnut hole will be eliminated entirely.
The U.S. Department of Health and Human Services (HHS) plans to beginbegan mailing the first group of rebate checks beginning on June 10, 2010. Checks will continue to be mailed as more people reach the doughnut hole in 2010.
Below are five facts people in Medicare Part D should know about the rebate check and their prescription drugs:
Receipts can help you track your spending. People in Medicare Part D who have paid more than $940 in out-of-pocket drug costs should automatically receive a check after reaching that threshold but you should save your receipts just in case. If you think you’ve reached the doughnut hole and don’t receive your check within a few months, having your receipts handy will be helpful when talking to Medicare.
Checks will be mailed automatically. Medicare tracks your drug costs for you. Once you reach the coverage gap, you will receive a check.
Protect yourself against scams. If someone says they can help you get your check more quickly if you pay them a fee, immediately report this scam or any similar fraud to the police or to the Montana Attorney General Steve Bullock’ s office at 406-444-2026 or at email@example.com. You should also report any suspected scam to Medicare by calling 1-800-MEDICARE (1-800-633-4227).
Your check will be mailed to the address Social Security uses to reach you. If you need to change your address, please call Social Security at 1-800-772-1213. If you prefer, a change of address may also be reported by calling or visiting your local Social Security office.
You may be able to save on your prescription drugs. By entering the name of each of your drugs, its dosage, and how often you take it into AARP’s Doughnut Hole Calculator, you can see when you are likely to enter the doughnut hole. This tool will also identify less costly drugs available in your Part D plan and will print out a personalized letter that will help you begin a conversation with your physician about switching to lower-cost alternatives.
Check aarp.org/getthefacts for more information on how the new health care law will affect you and your family.