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Medicare Resource Center
by Education & Outreach, September 27, 2010
People with Medicare Part D who reach the coverage gap — also called the "doughnut hole" — in their 2010 prescription drug plan will receive a $250 rebate check. This one-time, automatic payment will help 3 million people pay for the prescription drugs they need.
The first rebate checks were mailed in June 2010. Checks will continue to be issued as more people reach the coverage gap, which occurs when an individual has spent $2,830 (“the initial coverage limit”) in total drug costs for the year. Total drug costs include the full amount you and your insurance plan spend on your drugs, including your deductible, co-payments and coinsurance, but not the amount you pay in premiums.
What you need to know about getting a check
• You do not need to do anything to receive your $250 rebate check. The check, which will be made out in your name, will be mailed to you about three months after your total drug costs for 2010 have reached $2,830.
• You don't have to do anything to prove that you and your insurance plan have paid more than $2,830 in total drug costs. Your Medicare Part D plan tracks these costs for you.
• Rebate checks are sent automatically, so avoid anyone who promises to “help” you get your check. Scammers may say you'll receive your check more quickly if you pay them a fee. Immediately report this scam or any similar fraud to the police, your state's attorney general or to Medicare. You can find contact information for your state's attorney general in the blue pages of the telephone book or online at www.naag.org. Report any health care fraud to Medicare at www.stopmedicarefraud.gov, 800-MEDICARE or 800-633-4227.
• A printed, paper check will be mailed to the address Social Security uses to reach you. If you need to change your address, call Social Security at 800-772-1213. If you prefer, you can report a change of address by calling or visiting your local Social Security office.
• If you receive assistance in paying for your Medicare Part D costs through the Low-Income Subsidy (LIS), you will not receive a rebate check.
You may be able to avoid the gap in your prescription drug coverage and save money. AARP’s Doughnut Hole Calculator can show you if you'll fall into the doughnut hole this year. The calculator also identifies less costly drugs that are available in your Medicare Part D plan. Buying less expensive medications could delay when you'll reach the doughnut hole, or keep you out of the coverage gap altogether.
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