What is the Donut Hole?
By Jonathan Blum, Deputy Administrator and Director for the Center of Medicare at the Centers for Medicare and Medicaid Services
A number of visitors to www.HealthCare.gov have told us they’d like to know more about the Medicare “donut hole” in the Part D program.
If you aren’t familiar with Medicare, it is a health insurance program for people 65 or older, people under 65 with certain disabilities, and people with End-Stage Renal Disease (permanent kidney failure). People with Medicare have the option of paying a monthly premium for outpatient prescription drug coverage. This prescription drug coverage is called Medicare Part D.
In 2010, basic Medicare Part D coverage works like this:
For those that qualify, there is also a program called Medicare Extra Help that helps you pay your premiums and have reduced or no out-of-pocket costs for your drugs.
Needless to say, for most people with Medicare Part D, the donut hole presents serious financial challenges. Some people have had to choose between their rent or groceries and their prescription drugs.
But, the recent health reform law – the Affordable Care Act – has some important changes that will help to relieve this burden for the people with Medicare that hit the donut hole each year (and are not already on a program called Medicare Extra Help,):
If you would like more information on the one-time rebate check, feel free to check out this brochure or call 1-800-MEDICARE. (Please note that you do not need to do anything to receive this rebate check and should not provide any personal information such as Medicare, Social Security or bank account numbers to anyone calling about the rebate.)
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