Closing the Doughnut Hole


One of the first provisions of the Patient Protection and Affordable Care Act to take effect is the $250 rebate for Medicare beneficiaries who fall into the Part D doughnut hole. The rebates, which started going out in June, are part of a multiyear effort to trim drug costs for seniors and other Medicare beneficiaries.

Next year, patient cost sharing for brand-name drugs will be cut in half, and the doughnut hole will be closed completely by 2020.

Just as checks started hitting seniors' mailboxes, the administration launched a $1 million radio ad campaign to help patients protect themselves from scams targeted at the new benefits.

Marilyn Tavenner, acting administrator at the Centers for Medicare and Medicaid Services, answered questions about how the new benefit will be implemented.

Cardiology News: How many Medicare beneficiaries will fall into the doughnut hole this year? Will they all get checks this summer?

Ms. Tavenner: About 8 million Medicare beneficiaries are expected to reach the prescription drug coverage gap that we call the doughnut hole this year. Of those, 4 million will be eligible to get a tax-free, one-time rebate check. The remaining beneficiaries already receive assistance through Medicare Extra Help. Beneficiaries who hit this coverage gap do not need to fill out any form, or make any phone call, to receive this benefit under the Affordable Care Act. The $250 rebate checks will be mailed automatically to seniors' homes from Medicare when they enter the doughnut hole. Checks will be sent each month throughout this year as more beneficiaries enter the coverage gap.

CN: Will the $250 rebate have a significant impact on patients' out-of-pocket drug costs this year?

Ms. Tavenner: The rebate is immediate relief that marks the first step in completely eliminating the doughnut hole. This year's rebate will help put money back in the pockets of seniors who are too often forced to choose between paying for their groceries or for their medications. Next year, seniors who reach the coverage gap will get a 50% discount on brand-name drugs that will help reduce their costs. In addition, under the new law, the actual coverage gap will shrink each year until it completely disappears in 2020.

CN: Physicians in all specialties spend a lot of time helping patients find affordable medications. How will these changes decrease the burden on doctors?

Ms. Tavenner: Physicians are on the front lines in helping seniors obtain effective, affordable medications. Closing the coverage gap and making care more affordable will help Medicare beneficiaries get the care they need and deserve.

Starting next year, patients with Medicare can get free preventive care services such as colorectal cancer screening and mammograms. Medicare also will cover an annual physical, so patients can work with their physicians to develop a personal prevention plan based on current health needs.

CN: How can physicians help their patients take advantage of this new benefit?

Ms. Tavenner: Doctors can continue to help their patients by educating them about the Affordable Care Act so they can take full advantage of its benefits. If patients have questions on their rebate checks, they can call 1-800-Medicare or visit

Fraud-fighting tips can be found at

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