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?
Dear Need: One of the key benefits for seniors in the new healthcare reform law is improved coverage for Medicare Part D beneficiaries. Here’s what you should know.
Donut hole rebate
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.” 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 percent of your remaining costs for the year. Medicare will automatically send the rebate when you reach the donut hole; you should receive it within 45 days. You may want to call your drug plan once you’ve hit the donut hole, to make sure they’ve notified Medicare. If you don’t get your rebate check, call Medicare at 800-633-4227.
The government also warns seniors about possible con artists who may try to take advantage of the rebate. If someone calls you claiming to need your personal information, like your Medicare or Social Security number or bank account, don’t give it to them. Hang up the phone and call 1-800-MEDICARE.
Coming next year
You also need to know that, starting in 2011, Medicare Part D beneficiaries who hit the donut hole will receive a 50-percent discount on brand-name drugs and a 7-percent 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 percent 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.
Extra help changes
Another change to be aware of is Medicare’s expanded prescription drug benefit to low income seniors. Changes 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, annual income must be less than $16,245 for an individual and $21,855 for a married couple living together. And your assets — 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. Life insurance policies are no longer counted as assets and money received to help pay household expenses is not counted as income. To find out if you qualify, call Social Security at 800-772-1213 or see ssa.gov/prescriptionhelp.
Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.