Inform Article

Filling the Medicare Part D “Donut Hole”

07.07.2011
Posted by Nicole Stroud
Filling the Medicare Part D “Donut Hole” picture

Prepared By: Leadership Palm Beach County Class of 2011 in cooperation with Palm Beach County Medical Society

Summary of key provisions in the Affordable Care Act of 2010:
Filling the Medicare Part D "Donut Hole"


If you have Medicare prescription drug coverage and have to pay for your drugs in the "donut hole" in coverage, in 2010 you were eligible for a one-time, tax free $250 rebate from Medicare to help pay for your prescriptions.

What is the "Donut Hole"?
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). This is known as the "Donut Hole" or "Coverage Gap" in prescription drug coverage. The Explanation of Benefits notice, which your drug plan mails to you each month when you fill a prescription, should tell you how much you've spent on covered drugs and whether you've entered the coverage gap.

Filling the Donut Hole after 2011
Starting in 2011, if you have high prescription drug costs that put you in the donut hole, you'll get a 50% discount on Medicare Part D covered brand-name prescription drugs, and a 75% discount on Medicare Part D covered generic prescription drugs, while you're in the donut hole. Medicare Part D covered prescription drugs exclude drugs purchased from Canada or other foreign countries. The donut hole is scheduled to close in 2020.

Will I Need to do Anything to get this Rebate?
No. There are no forms to fill out. Medicare will automatically send you a check that's made out to you. If you do not receive your rebate check, contact Medicare at 1-800-MEDICARE. Individuals receiving "Medicare Extra Help" will not receive a rebate check.


Began June 2010.