Guide to Health Reform (Part 2): The Affordable Care Act passed by Congress and signed by President Obama this year contains some important benefits for Medicare recipients. 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.  This rebate is the first step toward closing the Medicare prescription drug coverage gap.

Medicare Sherpa analyzed the communication from Medicare and identified a few tips that will help you determine when you might receive your rebate from the government. Every Medicare plan must submit Part D prescription drug data to Medicare on a monthly basis. This data is used to identify if applicable Medicare Part D members (like you) have reached the coverage gap. Given the inherent delay already associated with receiving this type of data from Medicare plans, prompt submission by your Medicare plan is necessary to ensure that you will receive your rebate in a timely manner.

In the first step in this process, Medicare officials are mailing $250 rebate checks on June 2010 to some 80,000 seniors whose drug costs have pushed them into the doughnut hole, where they are paying their insurance plan’s full price for drugs. By the end of the year, nearly 4 million seniors will receive rebates, said Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services.

Help Us Spread the Word About this Important Benefit

• Medicare will be issuing rebate checks on a monthly basis starting in June 2010. Medicare will analyze prescription drug data to determine if you have reached the coverage gap (donut hole).
• Medicare's contractor Wisconsin Physician Services will mail the $250 rebate check to you along with a brief letter explaining why you are receiving the rebate.
• Medicare will only use the addresses on file in the Social Security database to send rebate checks to you and, therefore, you are responsible to send address corrections directly to Social Security.
• Medicare will not mail checks to addresses outside of the United States and its territories even if such addresses are on file with Social Security.
• In some instances, your Medicare plan will need to evaluate your claims information to determine if you actually reached the coverage gap (donut hole) and if all prescription data has been submitted to Medicare.
• If your Medicare plan determines that you have reached the coverage gap and that all supporting data records have been submitted to CMS, you will be instructed to wait at least four months after the month you reached the coverage gap before contacting 1-800-Medicare to lodge a complaint about delays in receiving your rebate.
• If your Medicare plan has not submitted the necessary data records or you have not actually reached the coverage gap, the Medicare plan should provide this explanation to you and promptly submit outstanding data records to Medicare, if applicable.

In the event that you contact 1-800-Medicare (1-800-633-4227) regarding the status of your rebate check after waiting at least four months after the month you reached the coverage gap, 1-800-Medicare will enter a complaint into the Complaint Tracking Module (CTM). Your health plan is responsible for resolution of assigned complaints within the appropriate Medicare resolution time frames. Medicare also will use these complaints to determine your eligibility for receiving a rebate check. You can always call 1-800-Medicare to report any issues concerning a rebate check you've received.

Stop Scams Against Seniors

Pass the attached brochure along to your friends, neighbors and family so they know the facts about this important program. Remember—there are no forms to fill out to receive this benefit once you qualify for it. 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. Go to stopmedicarefraud.gov to learn more about how Medicare is working with law enforcement to stop scams against seniors.

What's Next . . . Coming in 2011?

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

About the Author:

My name is Dana Cutter and I am Founder and Editor of Medicare Sherpa. Our staff spends their days searching the Internet for the best content and advice on retirement. On our site you will find articles on Social Security, Medicare Benefits, Prescription Drug Benefits and more. Please feel fee to send me an email with ideas for content, site improvements or general help launching your online persona. I hope you will consider joining and I am looking forward to reading more about you online.

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