Healthcare Reform: The Medicare “Donut Hole”

We have all heard this term in the news. It will affect all of us who work in the healthcare industry. Now that healthcare reform laws have been passed, you must educate yourself on the changes that are coming. A great place to start learning about the new requirements is to visit the following website:

http://www.whitehouse.gov/issues/health-care

As you read through the site, you will find that not everything passed with healthcare reform will be changing right away. Some things will go into effect sooner than others.

To help keep you up-to-date on healthcare reform, I will be posting a healthcare reform update periodically here on our blog.  Each post will cover a change that will go in effect in the law.

Closing the Donut Hole –

What is the “donut hole” you ask?  Medicare part D drug plans have a gap—when the patient reaches a certain dollar amount in coverage, Medicare will no longer cover prescription(s) until the patient has reached an out-of-pocket amount for medication. After the patient has reached their out-of-pocket amount in that year, Medicare will once again start benefits for prescriptions. This gap in coverage is called the Medicare donut hole.

There is an estimated four million senior citizens that reached the Medicare donut hole just this year. This makes it hard for seniors to get their medications. For 2010, a rebate check of $250 was sent to Medicare patients who had reached the donut hole in their Medicare plans.

According to www.healthcare.gov: “Starting in 2011, if you have high prescription drug costs that put you in the donut hole, you’ll get a 50% discount on covered brand-name drugs while you’re in the donut hole. Between 2010 and 2020, you’ll get continuous Medicare coverage for your prescription drugs.”

As a medical administrative assistant it will be very important for you to stay up-to-date on the changes that will affect patients when they visit your practice.  Medicare is a very complicated healthcare and patients look up to you for information.  If you do not have the answer for the patient then you should have them call The Centers for Medicare and Medicaid services at (800) MEDICARE (633-4227).

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