Reform Alert - News from the Blues' Office of National Health Reform

Medicare Part D beneficiaries will automatically receive $250 rebate when they reach "donut hole"

May 20, 2010

In 2010 only, seniors participating in Medicare Part D who are not already receiving Medicare Extra Help will receive a $250 rebate when they hit the "donut hole," or gap in prescription drug coverage that occurs when spending on covered Part D drugs, including co-pays and deductibles, exceeds $2,830.

The Department of Health and Human Services announced in April rebates would begin starting June 15. Once enrollees hit the prescription drug donut hole, or when the total amount the plan and the member pays for drug cost exceeds $2,830, the enrollee will be eligible for a $250 rebate. This applies to beneficiaries enrolled in individual and group plans, even if the plan covers prescriptions in the donut hole, as long as the enrollee is not receiving extra help though a low income subsidy.

The $250 check will be sent directly to enrollees from Medicare. Generally speaking, the enrollee should receive their check within four months of the date they enter the coverage gap or if their plan does not have a gap, when their total drug spend exceeds $2,830. However, the timeframe could vary depending upon the month in which the member enters the coverage gap.

There's no application process and no private company will be involved in getting rebate checks to Medicare Part D beneficiaries. Enrollees do not need to provide any personal information (such as a Medicare number or social security number) to get the rebate check. Enrollees should beware of potential fraud schemes and should not give any personal information over the phone to anyone who may call about the rebate.

The information on this website is based on BCBSM's review of the national health care reform legislation and is not intended to impart legal advice. Interpretations of the reform legislation vary, and efforts will be made to present and update accurate information. This overview is intended as an educational tool only and does not replace a more rigorous review of the law's applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. Analysis is ongoing and additional guidance is also anticipated from the Department of Health and Human Services. Additionally, some reform regulations may differ for particular members enrolled in certain programs such as the Federal Employee Program, and those members are encouraged to consult with their benefit administrators for specific details.

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