medicare part d
Health Reform Step-by-Step: The Doughnut Hole
The Patient Protection and Affordable Care Act is a long, complicated document that will cause real changes in the way that you and your family access and pay for health insurance. Texas Impact is committed to helping you understand the bill and making sure that you get the benefits available to you. In the coming weeks, we will pick apart the bill-- starting with the provisions that go into effect in 2010-- so you can see who will be affected.
Medicare Part D Drug Benefit Coverage Gap: The Doughnut Hole.
Since 2006, Medicare beneficiaries enrolled in a Medicare Part D prescription drug plan have experienced a gap in coverage that occurs once they have used up $2500 of drug payment benefits and before they have spent $4550 in out-of-pocket payments. This gap, known as the “doughnut hole,” typically affects about 4 million seniors who reach their full amount of medication benefits and do not quality for Medicare low-income assistance.
Beneficiaries who reached the “doughnut hole” in the first quarter of 2010 have already had a tax-free, $250 check mailed to them. Throughout 2010, this one-time rebate check will automatically be mailed to Medicare enrollees who qualify based on drug expenditures.
The Affordable Care Act will help seniors who face this benefit gap by gradually phasing in subsidies for medication, starting in 2011. Next year, seniors who reach the “doughnut hole” will experience a 50 percent discount on all brand-name medicines, with additional discounts for brand-name and generic drugs being added until the gap is closed in 2020.
The Kaiser Foundation offers a brief analysis of this provision of the law. To view it, click here.
For more information about this provision from Healthcare.gov, click here.
To read more about how the healthcare reform bill will affect Texas, click here.
Health Reform Step-by-Step: Extension of Young Adult Coverage
Health Reform Step-by-Step: Temporary High-Risk Pool
Health Reform Step-by-Step: Small Business Tax Credits
Health Reform Step-by-Step: Free Preventive Care
