Are You Eligible for the Part D $250 Rebate? CMS Posts Q&As

Are You Eligible for the Part D $250 Rebate? CMS Posts Q&As

The Affordable Care Act passed by Congress and signed by President Obama this year contains some important benefits for Medicare recipients. One benefit is the $250 rebate to help with beneficiaries’ Medicare Part D drug costs. Beneficiaries who do not receive the low-income subsidy (LIS), will automatically receive this one-time $250 rebate check from Medicare after they reach the coverage gap (also called the “donut hole”) in 2010. This rebate is the first step toward closing the Medicare prescription drug coverage gap as mandated in the new health care reform law.

Below are a few common questions and answers on this $250 rebate that the Centers for Medicare and Medicaid Services (CMS) sent out last week. Please share it with your colleagues and beneficiary clients.

What is the coverage gap and how will I know if I’ve reached it?

Most Medicare drug plans have a coverage gap. This means that after you and your plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your drugs (up to a limit).

The Explanation of Benefits notice, which your drug plan mails to you each month when you fill a prescription, will tell you how much you’ve spent on covered drugs and whether you’ve entered the coverage gap.

Will I need to do anything to get this rebate check?

No. There are no forms to fill out. Medicare will automatically send a check that’s made out to you. You don’t need to provide any personal information like your Medicare, Social Security, or bank account numbers to get the rebate check. Don’t give your personal information to anyone who calls you about the $250 rebate check. Call 1-800-MEDICARE (1-800-633-4227) to report anyone who does this. TTY users should call 1-877-486-2048.

When will I get the rebate check?

If you reach the coverage gap this year and enter the Part D “donut hole”, you will receive a one-time $250 rebate check if you are not already receiving Medicare Extra Help.  These checks will begin to get mailed to beneficiaries starting in mid-June.

Checks will be mailed monthly throughout the year as beneficiaries enter the coverage gap. However, this is a one-time benefit and beneficiaries who qualify will only receive one check after they reach the coverage gap.

What if I don’t get the rebate check when I should?

Beneficiaries who hit the donut hole after the program has begun should expect to receive their check within 45 days. Your rebate may be delayed if Medicare doesn’t have information from your Medicare drug plan showing that you reached the coverage gap in time to include you in the next mailing. You should call your Medicare drug plan to make sure all of your information has been sent to Medicare.

If you don’t get your rebate check, contact Medicare. Individuals receiving Medicare Extra Help will not receive a rebate check.

You can also check to make sure Social Security has your correct home address. Call 1-800-772-1213 or your local Social Security office. TTY users should call 1-800-325-0778.

What’s Next ….Coming in 2011

If you reach the coverage gap in 2011, you may get a 50% discount on your brand name prescription drugs at the time you buy them. Stay tuned for more information from Medicare.

Help  stop scams against beneficiaries

Remember- there are no forms to fill out to receive this benefit once someone qualifies for it. Medicare will automatically send a check that’s made out to the qualified beneficiary.

Beneficiaries also don’t need to provide any personal information like their Medicare, Social Security, or bank account numbers to get the rebate check. Please remind them to NOT give their personal information to anyone who calls them about the $250 rebate check. They should call 1-800-MEDICARE (1-800-633-4227) to report anyone who does this. TTY users should call 1-877-486-2048.

Go to stopmedicarefraud.gov to learn more about how Medicare is working with law enforcement to stop scams against seniors.

More questions about the $250 rebate check or the Affordable Care Act and Medicare?

Beneficiaries with more questions can refer to the brochure Medicare and the New Health Care Law–What it Means for You (PDF) that Medicare sent them. (Also available in Spanish (PDF)). They can also visit www.medicare.gov, call 1-800-MEDICARE, or visit www.healthreform.gov.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

2 Comments

  1. Rebecca Elswick 8 years ago

    Hi Karen,
    I work for a local hospital in San Diego and I assist seniors navigate the system.
    I have a question regarding the 40 quarters of employment requirement to be eligible for Part A Medicare benefits without having to pay out-of-pocket.
    Does this have to be 40 quarters or 10-years of full-time work or can it be part-time? In other words, is there a weekly or quarterly hour requirement?
    Please e-Mail the answer to me at rebecca.elswick@sharp.com.
    Thank you, Karen,
    Rebecca

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  1. […] in the years ahead and completely closes the donut hole by 2020. (See our past blog article, Are You Eligible for the Part D Rebate: Q & A for more […]

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