Closing the Prescription Drug Coverage Gap

You could be eligible for a $250 rebate this year to help with your Medicare drug costs.

What’s Next...Coming in 2011

If you reach the coverage gap in 2011, you will get a 50% discount on your brand name prescription drugs at the time you buy them, unless you are already getting Medicare Extra Help. Stay tuned for more information from Medicare.

Have other questions about the $250 rebate check or the Affordable Care Act and Medicare?

Please refer to the brochure Medicare and the New Health Care Law—What it Means for You that Medicare has sent you. You can also visit www.medicare.gov, or call 1-800-MEDICARE.  The Affordable Care Act passed by Congress and signed by President Obama this year contains some important benefits for Medicare recipients.

If you have Medicare prescription drug coverage, and aren’t already getting Medicare Extra Help, Medicare will automatically send you a tax free, one-time $250 rebate check after you reach the coverage gap (also called the “donut hole”) in 2010. This rebate is the first step toward closing the Medicare prescription drug coverage gap.

What is the coverage gap and how will I know if I’ve reached it?

Most Medicare drug plans have a coverage gap. This means that after you and your plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your drugs (up to a limit).
The Explanation of Benefits notice, which your drug plan mails to you each month when you fill a prescription, will tell you how much you’ve spent on covered drugs and whether you’ve entered the coverage gap.

Will I need to do anything to get this rebate check?

No. There are no forms to fill out. Medicare will automatically send a check that’s made out to you. You don’t need to provide any personal information like your Medicare, Social Security, or bank account numbers to get the rebate check. Don’t give your personal information to anyone who calls you about the $250 rebate check. Call 1-800-MEDICARE (1-800-633-4227) to report anyone who does this. TTY users should call 1-877-486-2048.

When will I get the rebate check?

If you reach the coverage gap this year and enter the Part D “donut hole”, you will receive a one-time $250 rebate check if you are not already receiving Medicare Extra Help. These checks will begin to get mailed to beneficiaries starting in mid-June.

Checks will be mailed monthly throughout the year as beneficiaries enter the coverage gap. However, this is a one-time benefit and if you qualify, you will only receive one check after you reach the coverage gap.

Will I have to pay taxes on this rebate check?

No. You don’t have to pay taxes on your $250 rebate check. It is tax free.

What if I don’t get the rebate check when I should?

If you hit the donut hole after the program has begun, you should expect to receive your check within 45 days. Your rebate may be delayed if Medicare doesn’t have information from your Medicare drug plan showing that you reached the coverage gap in time to include you in the next mailing. You should call your Medicare drug plan to make sure all of your information has been sent to Medicare.

If you don’t get your rebate check, contact Medicare at 1-800-MEDICARE. Individuals receiving Medicare Extra Help will not receive a rebate check.

You can also check to make sure Social Security has your correct home address. Call 1-800-772-1213 or your local Social Security office. TTY users should call 1-800-325-0778.

Citations.

Medicare.gov Closing the Prescription Drug Coverage Gap - 11464