WASHINGTON â€“ This morning, Congressman Bill Owens announced that, beginning today, Medicare will begin mailing out to tens of thousands of seniors $250 â€˜donut holeâ€™ checks. Under the recently enacted health reform law, seniors who fall in the donut hole coverage gap in 2010 will receive this one-time tax-free $250 rebate check. These checks will continue to be mailed monthly over the next several months as seniors enter the coverage gap.
â€œThis is just one example of how health care reform will strengthen Medicare and help seniors,â€ Owens said. â€œThe so-called Donut Hole has hit the wallets of Upstate New York seniors for far too long, and itâ€™s well past time that the situation be corrected. Prescription drugs cost our seniors thousands of dollars a year and, while this payment will not correct this issue immediately, we are on pace to completely close the donut hole in ten years.â€
The checks are the first benefit from health reform for seniors in the Medicare Prescription Drug program. Beginning in January 2011, seniors in the donut hole will receive a 50% discount on brand name drugs. By 2020, the donut hole will close completely.
Seniors are subject to the donut hole if their prescription drugs cost too much to be paid for through basic Medicare coverage, but aren’t expensive enough to qualify for catastrophic coverage. The â€˜donut holeâ€™ coverage gap is the period in the prescription drug benefit (once their prescription drug costs exceed $2,830) in which the beneficiary pays 100 percent of the cost of their drugs until they hit the catastrophic coverage threshold.
|Cost of Rx||Cost to Patient||Covered by Medicare|
|0â€“$295||100% of Rx cost||No Medicare coverage|
|$295â€“$2,830||25% of Rx cost||75% covered by Medicare|
|$2,830-$6,440||100% of Rx cost||No Medicare coverage|
|over $6,440||5% of Rx cost||95% covered by Medicare|
â€œLast year, almost a quarter million Medicare beneficiaries in New York fell into the donut hole and received no extra help to defray the cost of their prescription drugs. Recent health care reform is beginning to bring much needed relief to our seniors,â€ Owens added.
Medicare recipients donâ€™t have to do anything to get the $250 check â€“ once their drug costs for the year hit $2,830 the one-time check will be issued automatically.
Making prescription drugs more affordable for seniors is only one of the many benefits for seniors included in the recently enacted health reform law. Other benefits for seniors include:
* Provides free preventive care services under Medicare, beginning in 2011.
* Strengthens Medicare by extending its solvency by an additional 12 years, from 2017 to 2029.
* Improves seniorsâ€™ access to doctors.
* Continues to reduce waste, fraud and abuse.
* Improves care by helping doctors communicate and coordinate.
* Expands home and community-based services to keep seniors in their home, instead of in nursing homes.