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CONNECT TO | Policy & Legislation
July 2010

Fraud Prevention Education Campaign Targets Medicare Beneficiaries
Ensuring Seniors Have the Information They Need to Protect Themselves

The U.S. Department of Health and Human Services (HHS) has begun sending $250 rebate checks to consumers in the Medicare drug coverage gap, also known as the "doughnut hole." HHS will send an estimated 80,000 checks to people who have entered the coverage gap since the start of 2010, and will continue to send the rebates on a rolling basis approximately every month to people who newly enter the doughnut hole.

Last year, roughly 156,000 Medicare beneficiaries in Ohio hit the doughnut hole.

rebate checks

As eligible seniors receive their tax-free, one time rebate check, partners in the State of Ohio's Take Action - Protect Yourself from Fraud program are cautioning seniors with Medicare to be on the alert for scams involving the checks. HHS, the Administration on Aging and the Centers for Medicare & Medicaid Services (CMS) have launched a national education effort to ensure that seniors have the information they need to protect themselves from potential scams or fraud when it comes to their Medicare benefits. Stopmedicarefraud.gov details how Medicare is working with law enforcement to stop scams against seniors.

Senior citizens are being warned that scammers might try to trick them into providing personal information such as bank account and Social Security numbers to expedite receipt of their rebates. Seniors should be on the look-out for scams where people they don't know ask them for their personal information in order to get their checks.

Beneficiaries do not need to provide any personal information, such as Medicare, Social Security or bank account numbers to get the rebate check. Senior citizens are being warned not to give any personal information to anyone who calls about the $250 rebate check.

The federal government tracks prescription drug spending and automatically issues checks to those who qualify for rebates and are not already receiving Medicare Extra Help. There are no forms to fill out. Checks will be mailed in envelopes bearing the Department of Health and Human Services logo to the same address Medicare uses to send beneficiaries information now.

Rebate checks will be mailed monthly as beneficiaries enter the coverage gap. Beneficiaries who hit the doughnut hole should expect to receive their checks within 45 days. This is a one-time benefit and beneficiaries who qualify will only receive one check after they reach the coverage gap. Individuals receiving Medicare Extra Help will not receive a rebate check.

Take Action and AARP Ohio advise seniors:

  • Save receipts for any out-of-pocket drug costs. If you think you have reached the doughnut hole and have not received your check within a few months, having the receipts will be helpful when talking to Medicare.
  • Checks will be mailed automatically to those who qualify within 45 days of reaching the gap. You do not have to do anything. Medicare tracks your drug costs for you. Once you reach the coverage gap, you will receive a check.
  • Checks will be mailed to the address Social Security uses to reach you. If you need to change your address, call Social Security at 1-800-772-1213. If you prefer, a change of address may also be reported by calling or visiting your local Social Security office.
  • If an unsolicited visitor comes to your home or someone calls you saying they are a representative from Medicare and need personal information to process your Part D rebate, calmly request their personal information (e.g., name, business affiliation and phone number) and inform them you will call them back. Do not call them back, but instead, immediately contact the local police, the Ohio Attorney General's Office at 1-800-282-0515 or online at www.speakoutohio.gov, or the Take Action program at 1-800-686-1526.

The health reform law gradually phases out the doughnut hole. This year, people who enter the coverage gap will receive the one-time $250 rebate check. Beginning next year, consumers in the doughnut hole will receive a 50 percent discount on brand-name drugs and a 7 percent discount on generics. The share consumers pay for both brand-name and generic drugs will decrease until the gap is eliminated in 2020, when consumers will pay the standard 25 percent of the costs for drugs while in the doughnut hole.

CMS has created a free brochure, Closing the Prescription Drug Coverage Gap, which details the rebate check program.

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Policy & Legislation

Thousands To Receive Coverage Gap Rebate in June
As required by the new health care reform law, on June 15, the U.S. Department of Health and Human Services (HHS) will begin sending $250 rebate checks to Medicare consumers who have entered the Part D prescription drug coverage gap this year. HHS will continue to mail checks approximately every six weeks. Participants should see their rebate check approximately three months after hitting the donut hole. An estimated four million Medicare consumers will receive checks in 2010, and about 80,000 individuals will receive theirs in June. People who qualify for the rebate will receive it automatically and will not need to fill out any forms. Participants who currently receive "extra help" with their Medicare costs will not receive the $250 rebate.

Three Papers on Medicaid Long-Term Services and Supports
The Center for Health Care Strategies has produced three documents as part of its Innovations in the Medicaid Continuum of Care series, which was developed to help state and federal policymakers identify high-quality and cost-effective strategies for addressing the full range of clinical and long-term supports and services (LTSS) needs of Medicaid beneficiaries. The reports include: Systems of Care: Environmental Scan of Medicaid-Funded Long-Term Supports and Services, Medicaid-Funded Long-Term Supports and Services: Snapshots of Innovation, which presents an array of alternatives for reforming the delivery of LTSS, and the policy brief, Medicaid-Funded Long-Term Care: Toward More Home- and Community-Based Options.