The check is in the mail — or it will be once a Medicare beneficiary hits the “doughnut hole” of Part D prescription drug coverage. There is no application process, there will be no phone call requesting information and no promises of getting the $250 rebate provided in health reform legislation faster.
Sandy Prager, Kansas Commissioner of Insurance, is urging Medicare beneficiaries to be wary of scams surrounding the federal payment program.
“The Department of Health and Human Services is mailing the checks to Kansans who are eligible once they have reached the ‘doughnut hole,’” Praeger said. “No Medicare official or anyone else should be contacting you to request personal or financial information. If someone tells you he or she can get your check to you faster for a fee, report it.”
The term “doughnut hole” refers to a gap in prescription drug coverage that a beneficiary must pay when their total drug spending equals $2,830. The coverage gap extends to $6,440 in total drug spending.
The federal health reform law enacted earlier this spring phases out the doughnut hole by 2020 and provided the $250 “rebate” for this year only. The Centers for Medicare and Medicaid Services began sending checks on June 10.
Kansas Attorney General Steve Six said that individuals might try to convince seniors that:
• the check needs to be transferred to a third party,
• the money needs to be used to cover a specific payment,
• the beneficiary is required to give personal information.
“It is important that seniors understand they do not have to take any action to receive their rebate,” Six said. “Once you reach the threshold with Medicare, the rebate will be issued automatically.
“I encourage seniors to educate themselves, and I also encourage Kansans with elderly friends or family members to be aware of these scams and talk to their loved ones about being vigilant.”
“Remember, if you think something is amiss, stop the transaction, call the Kansas Insurance Department, and confirm that the transaction is legal,” Praeger said.
Approximately 27.6 million Americans were enrolled in Medicare Part D as of February 2010 and more than one in four will reach the gap. About 80 percent of enrollees do not have any gap coverage, causing some to stop taking their prescriptions when they must pay the full price.
Beginning in 2011, Part D beneficiaries who reach the doughnut hole will get a 50 percent discount. This will be phased up to 75 percent discount on brand name drugs by 2020 and a 7 percent discount on generic drugs, thereby effectively closing the doughnut hole.
