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Medicare $250 "donut hole" checks are in the mail

Megg Mueller | June 14, 2010

Riddle: When is a doughnut hole not a fabulous treat?

Answer: When it's a huge gap that your Medicare prescription drug plan falls into.

Gaps in Medicare coverage can leave a bad taste in your mouth as you struggle to pay for needed medications. But the health care reform law is attempting to fill the hole, albeit incrementally.

Bridging the Medicare gap

In early June, the government sent out its first wave of $250 rebate checks to Medicare beneficiaries who have reached the annual cap on their plan's prescription reimbursement, but haven't yet hit the catastrophic level where the plan kicks back in. Seniors often find themselves lost in this "donut hole" of no prescription coverage in which they may end up paying thousands of dollars out-of-pocket.

The rebate check is the first step to permanently close the coverage gap. It's a one-time deal; the donut hole coverage gap is to slowly close each year--until 2020 when the gap is supposed to be closed for good.

Is it enough?

While 4 million seniors are set to get this $250 supplement, for many it may just not be enough to close the wide gap in coverage. While Medicare prescription plans differ, in California, Medicare recipients lose coverage when their annual drug costs hit $2,830, and don't kick back in until they reach $4,550, according to the San Jose Mercury News. While the rebate will help, the potential out-of-pocket expense for most would still be almost $1,500--which may simply be more than many seniors on fixed incomes can afford.

In some cases, the rebates aren't even going to Medicare recipients. In Vermont, for example, low-income seniors have been asked to send their $250 checks to the state coffers. CNNMoney.com reports that the state's prescription plan covers drug costs once the Medicare user falls into the gap--so the state claims they are entitled the federal government's rebate, not the patient.

Contact Medicare directly

Sadly, as soon as the checks were sent, the Chicago Sun-Times reported that scam artists apparently started calling seniors asking for critical personal info (such as Social Security numbers or bank account information), saying it was required to get the check.

This is not true; checks are automatically mailed to eligible Medicare recipients. Do not share any information if you get such a phone call. If you don't get your check within 45 days of hitting your gap in coverage, call Medicare directly.

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