My pharmacy has upped the price of my prescriptions because I am in the “donut hole” The TV news says rebate checks are in the mail. The person at the pharmacy says she knows nothing about rebates. [BTW: the price went up 1000% from $14 to $146 on each of three prescriptions.]
Where does it tell me how to get a rebate check?
According to Medicare, you shouldn’t have to do anything. The process will be automatic. You don’t need to provide any personal information. Medicare will send you a check 45 days after the end of the calendar quarter in which you fell into the gap. Of course, you should call your provider if you have any questions.
There is also a .pdf you can download from here with more information. This a link to the download page, not to the actual .pdf itself. Again, you should call your provider to make sure they have sent your information to Medicare, or if you don’t get your check when you feel it should have arrived.
One thing to keep in mind, from the way I understand it, you need to actually get a prescription filled and picked up while in the donut hole (so just reaching it doesn’t do anything, you need to actually pay the “extra”), and it is a single check of $250, no matter how much you pay while in the hole.
What the heck is a donut hole in this context?
Uber short version …
Medicare pays for most of your drug prescriptions up to an annual limit of a couple thousand (-ish), then pays a much smaller percentage for the next couple thousand (-ish), then picks up almost all of the cost of the rest.
So if you have truly catastrophic drug costs, Medicare will cover the vast majority. And if you have minor costs, it’ll also cover the majority. But if you have *typical to high for an elderly person *costs, then you end up with a much smaller average reimbursement. And a huge jump in out of pocket costs when you first exceed the lowest tranche of OOP costs.
The idea is to protect the poor, and protect the truly devastated, but not try to pay for everything for everybody.
As the politicians were debating enacting all this a few years ago, the low-paying middle tranche in the three tiers of coverage was nicknamed the “donut hole”.
Medicare Part D pays for your prescriptions less a copay until you reach a certain amount of spending. Then it covers nothing until you reach a second amount of spending, when it covers you again.
Also, janeslogin, to be fair it’s not your pharmacy that upped the price of your prescriptions, it’s your Part D and the way the law was set up (to screw you, frankly).
ETA: I’m wrong on the covering nothing part. I didn’t realize it covers a smaller percentage.
You will be eligible for the check when your drug spend, which is the total cost of your medications for the year, exceeds $2830.00. The only exception is if you get a low income subsidy from medicare. Not all med d plans have a coverage gap per se. Some plans provide coverage during this benefit stage. Regardless, those members also get the check. Plus, you don’t pay taxes on the check.
I got my check for $250 without doing anything.
My social security is direct deposited and my medicare premiums are automatically withdrawn and my co-pay is automatic - but - my $250 is a paper check via USPS.