August 31, 2010

Discount Prescription Card & Health Care Reform for Medicare Beneficiaries

richardBy Richard J. Schillig, CLU, ChFC, LUTCF
Independent Insurance and Financial Advisor

Working with Medicare and all the issues involved with choices and costs, we came across another very important resource for Medicare and Pre-Medicare folks – free discount prescription cards. These cards are available at no cost and is available just for the asking. The card is available for persons on Medicare or persons not yet on Medicare. The discount promises to be up to 40% on brand name medications and up to 60% for generics at participating pharmacies. We did a spot check and most pharmacies in this area accept the discount prescription card. I understand the discount card can be used by Medicare beneficiaries in the “donut hole” with their prescription plans. Remember the ‘donut hole’ starts when the total cost of medications for the calendar year – that’s the amount you pay – your co-payment or coinsurance AND the amount paid by the insurance company reaches $2,830 for the calendar year. When you reach this number you are in the ‘donut hole’ and must pay 100% of the costs of prescriptions. It is my understanding the discount card is available for use for persons in this gap or donut hole.

This discount card, available at no cost can be used by anyone – one card is sufficient for spouses or for the entire family. If you would like to have one of these cards, contact us at 563.332.2200 or email We will be happy to get one to you.

I’d also like to share with you a couple thoughts on how the new health care reform law affects the “donut hole.” The Patient Protection and Affordable Care Act (PPACA) includes changes that affect beneficiaries who fall into the ‘donut hole.’ Part D members who are not already
receiving Medicare Extra Help will receive a $250 Medicare Rebate Program check after they reach the gap. The U.S. Dept. of Health and Human Services began sending out checks to those who hit the donut hole in mid-June. These one-time, tax-free rebate checks are mailed within 45 days of reaching the donut hole. The checks are mailed automatically. There are no forms to fill out. Distribution of checks began the week of June 14, 2010. If you are in the donut hole – you will not have to take any action. The government will issue these checks automatically. Remember though checks will be processed within 45 days of medicare being notified that you are in the donut hole. If you believe that you should have received a check and have not, or have any other questions on this rebate, call your Medicare part D insurance company for specific information. Remember too the qualification for the rebate check is you are NOT now eligible for ‘extra help’ in paying the costs of medications. If you are receiving extra help, then my understanding of this law is you do not receive the $250 rebate check.

Medicare has a brochure at their site When you open that site – in the middle of the opening page, there is a nice breakdown of this information. If you do not have computer or Internet access, please call our office. We will be happy to send you a publication or brochure on the reimbursement plan.

If you are not sure how close to the donut hole you are, check the EOB – explanation of benefits statement you receive each month. While I am talking about EOBs – boy – get to know that term and that publication. With any health insurance, including Medicare, that has prescription drug coverage, you receive an EOB – Explanation of Benefits – each month. EOBs are issued when you have a claim. When you go to the doctor’s office this month…sometime in mid September you will receive an EOB that shows the amount of claim and how that claim was handled. This is true for all insureds regardless if Medicare or pre-Medicare. If you have no claims for the month, you will not receive an EOB but if you have a claim – major medical claim, doctor office visit, or prescription drug filled – that’s a claim and you will receive an EOB. Most insurance companies provide a separate EOB for prescriptions….those EOBs are important. Hang on to them, create a file each year for the EOBs – they are important documents. I find the elderly sometimes don’t do a good job of keeping the EOBs – so if you have an elderly relative and are helping them with costs of health care, be sure you begin to track those EOBs – they are so very important. Determine if that person is becoming near the “donut hole” for prescription medications. If that’s the case, the discount prescription card could be very helpful. Call on us anytime for assistance.