Savvy Senior

Financial Assistance for Medicare Part D Beneficiaries

Dear Savvy Senior:

In one of your recent columns (What Healthcare Reform Means for Seniors) you wrote that seniors with a Medicare prescription drug plan could get a $250 rebate check when they hit the donut hole. I’ve just hit it! What do I need to do to get my check and how long will I have to wait?

Need Help

Dear Need,

This year, seniors who have a Medicare Part D prescription drug plan are automatically eligible to receive a one-time $250 rebate check if they hit the “donut-hole” coverage gap and are not already receiving Medicare “Extra Help.” Medicare expects approximately 4 million Part D beneficiaries will actually hit the donut hole in 2010.

The donut hole begins after you reach $2,830 in total prescription-drug spending, and extends until your total drug costs for the year reach $6,440. Within that gap, you generally have to pay the bills out-of-pocket. After that, your Part D plan usually covers 95% of your remaining drug costs for the year.

Again, you just need to reach the donut hole to qualify for the rebate. You don’t have to spend $250 within the coverage gap first. And you don’t need to fill out any forms to get your check. Medicare will automatically send it when you reach the donut hole–you should receive it within 45 days. But you might want to call your drug plan once you’ve hit the donut hole in order to make sure they’ve notified Medicare of your eligibility. Call Medicare at (800) 633-4227 if you don’t get your rebate check.

Scam Alert

The government also warns seniors about possible con artists who might try to take advantage of the government rebate. If someone calls you claiming to need any personal information so they can process your Medicare rebate check, don’t give it to them. It’s a scam! Just hang up the phone, and call (800) MEDICARE to report it.

Coming Next Year

You also need to know that, starting in 2011, Medicare Part D beneficiaries that hit the donut hole will receive a 50% discount on brand-name drugs and a 7% discount on generic prescriptions. After that, beneficiaries will pay a smaller portion of their drug costs in the donut hole each year until 2020, when they have to pay just 25% of those costs.

Also starting next year, individuals who earn more than $85,000 (or $170,000 if married filing jointly) will have to pay a high-income surcharge for Part D Premiums, as they do for Part B.

Extra Help Changes

Another change to be aware of is Medicare’s expanded prescription drug benefit to low income seniors (this is not part of healthcare reform). Changes in the law have now made it easier for about 1 million more seniors to qualify for “Extra Help” in paying their Medicare drug coverage.

To be eligible, your annual income must be less than $16,245 for an individual and $21,855 for a married couple living together. And your assets such as stocks, bonds and bank accounts must be limited to $12,510 for singles and $25,010 for married couples. The value of your home and automobiles are excluded.

Call Social Security at 800-772-1213 or see ssa.gov/prescriptionhelp to find out if you qualify.