Recent News & Events

 

Question: I hear that seniors get $250 for medicines if they fall into the doughnut hole. When do we get this, and how? When do we get rid of the gap in coverage?

Answer: The new law requires the federal government to send seniors enrolled in Medicare Part D drug plans a $250 check if they hit the limit for drug expenses this year and fall into the coverage gap, or “doughnut hole.”

“You don’t have to do anything,” says Vicki Gottlich, senior policy attorney at the Center for Medicare Advocacy in Washington. You should get a check within three months after the quarter of the year in which you entered the gap. So if you fall into the gap in July, which is in the third quarter of the year, you should get a check by the end of December. The first checks are due to be mailed June 15.

Currently, going into the gap means paying 100 percent of the cost of your drugs out of your own pocket until your expenses reach a certain limit. But beginning next year, the doughnut hole will slowly shrink:

• You will get a 50 percent discount on brand-name and biologic prescription drugs that you buy in the gap in 2011. Starting in 2013 the federal government will gradually add to these discounts so that by 2020 you will be paying no more than 25 percent of the cost.
• Generic prescription drugs will get a 7 percent price cut starting in 2011. By 2020, the federal government will cover 75 percent of the cost of these drugs. By 2020, the gap will disappear. It’s important to know that the discounts do not affect your ability to qualify for catastrophic coverage if the actual costs of your drugs are high enough to reach that level.