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Medicare "Donut Hole" Rebate Checks

Maynard, MA - (August 4, 2010) - Today, PlanPrescriber (, a wholly-owned subsidiary of eHealth, Inc. (NASDAQ: EHTH) released a list of frequently asked questions (FAQ) for Medicare beneficiaries to help them understand who qualifies for the $250 rebate check and what measures they can take to avoid reaching the donut hole.

In June 2010, Medicare sent the first $250 donut hole rebate checks to Medicare Part D beneficiaries who entered the coverage gap in 2010. The Department of Health and Human Services estimates that over 4 million seniors will receive a $250 rebate in 20101.

FAQs Regarding the $250 Donut Hole Rebate

Question: Who qualifies for the $250 rebate check?

Answer: If you have Medicare Part D prescription drug coverage and your prescription drug costs fall into the donut hole, then this year you may receive a one-time, tax-free rebate of $250 from Medicare to help you cover your prescription costs.

Question: Why are rebate checks being made available?

Answer: The one-time donut hole rebate checks issued in 2010 will be the first step in the Affordable Health Care for America Act's plan to gradually eliminate the donut hole by 2020.

Question: Why are rebate checks only available in 2010?

Answer: Beginning in 2011, Medicare Part D beneficiaries who fall into the donut hole will receive a 50% discount on their brand name prescription drugs and a 7% discount on generic drugs. The discounts will gradually increase until the donut hole is eliminated.

Question: What do I need to do in order to receive my rebate check?

Answer: You do not need to provide any personal information or fill out any forms to receive this benefit. Medicare will automatically send you a check when you qualify.

Question: Can I work with a third party in order to get my rebate more quickly?

Answer: No!

The Secretary of Health and Human Services, Kathleen Sebelius, has warned Medicare beneficiaries that there are scam artists claiming that they're able to speed up the rebate process if you pay them a fee or provide them with your personal information.

Do not provide any personal information (social security numbers, Medicare identification numbers, or bank account information) to anyone who calls, emails, comes to your door, or claims to be from the government. Call 1-800-MEDICARE (1 800-633-4227) to report anyone who tries to use the $250 donut hole rebate to mislead you.

Question: When can I expect to receive my rebate check?

Answer: The U.S. Department of Health and Human Services will issue paper checks each month from June until the end of 2010. You should receive your rebate check automatically within 45 days after you enter the donut hole.

Question: How will Medicare know that I have reached the donut hole and that I qualify for the rebate?

Answer: Your Medicare Prescription Drug Plan will provide the Department of Health and Human Services with the information that shows you have reached the coverage gap and are eligible for the $250 rebate check.

Question: Do I have to pay taxes on my donut hole rebate?

Answer: You don't have to pay any taxes on your $250 rebate check. The rebate is tax-free.

Question: I entered the donut hole at the beginning of May and I still haven't received my rebate check. What should I do?

Answer: If it has been more than 45 days since you reached the coverage gap and you haven't received the rebate, Medicare may not have the information from your Medicare Prescription Drug Plan that shows you have reached the coverage gap. In this case, you should call your Medicare Part D insurance provider and make sure that all of your information has been sent to Medicare.

Question: I have Medicare Extra Help. Will I still qualify for the rebate?

Answer: In most cases, people on the Medicare Extra Help plan pay little or no money out-of-pocket for their prescription drugs and are, therefore, not eligible to receive the rebate check.

Question: Will my Medicare Part D plan premiums increase because of these government rebates and the discounts in 2011?

Answer: As they have in years past, Medicare premiums are likely to increase in 2011. However, the $250 rebate checks and the new discounts on prescription drugs, in and of themselves, should not directly result in increases to your Medicare Part D plan premiums in 2011.

It's probable that the discounts on prescription drugs could work to minimize premium increases, as fewer seniors will exceed their "donut hole" catastrophic coverage limit. Once seniors exceed that limit, their insurer has to cover the remaining costs of the prescription drugs, which in turn forces premiums to increase. If fewer seniors exceed that limit, insurers would presumably have lower costs. If costs are lower, the savings could be passed on to seniors.

Additional Information for Medicare Part D Beneficiaries

What is the Medicare "Donut Hole"?

Persons enrolled in a Medicare Part D Prescription Drug Plan reach the coverage gap or "donut hole" after their plan has paid $2,830 of their medication costs. Medicare enrollees in the "donut hole" currently pay 100% of their medication costs during this period until their total out-of-pocket expenses for drugs on the plan's formulary reach $4,550. At this point when the $4,550 is reached, what is known as "catastrophic coverage" kicks in and enrollees only pay 5% of drug costs for the rest of the year. At the beginning of each year, Medicare Part D coverage resets, and enrollees return to the plan's initial coverage.

How do you know if you've reached the "donut hole"?

Your prescription drug plan provider will mail you an "Explanation of Benefits" notice each month that you fill a prescription. This notice will summarize how much you've spent on the plan's covered medications and whether you have entered the coverage gap.

Avoiding the "Donut Hole" altogether

Many Medicare enrollees are on a fixed income, so every dollar counts! No one wants to end up in the donut hole if they can avoid it. Luckily there are some things that you can do to minimize your risk of reaching the donut hole. Certain Medicare Part D plans offer drug coverage in the donut hole, some offering gap coverage for all drugs on the plan's formulary and others covering a limited number of drugs. You can use PlanPrescriber's Medicare Part D comparison tool to find plans in your area that offer gap coverage.

Another way to help minimize your risk of falling into the donut hole is to try generic alternatives to brand name drugs. Generics are typically sold at a much lower price than brand name drugs. Discuss this option with your doctor or pharmacist to see if there are generic alternatives to your current medications.

Additionally, you can lower your prescription drug costs by using a mail-order service for those medications that you take regularly. This can lead to substantial savings, keeping those drug costs low.

Lowering your out-of-pocket expenses for medications

In addition to looking for Part D plans with gap coverage, it is important to make sure you select a Medicare Part D plan that covers as many of your prescriptions as possible. Otherwise you will have to pay out of pocket for any medications not covered by your plan's formulary, and the money you spend on these drugs will not count towards the catastrophic coverage threshold. If you do end up in the donut hole, you will then end up having to pay 100% of the cost of all your medications, those covered and those not covered by your plan. You can see what Medicare Part D plans cover your prescriptions by going to the Medicare Part D comparison tool. All you have to do is enter your zip code, your prescription drugs and dosage, and you can begin your personalized plan comparison.

If you are struggling to pay for your medications, you can also apply for public assistance, or you can apply directly to certain pharmaceutical companies for help through a Prescription Assistance Program (PAP).


PlanPrescriber (, a wholly-owned subsidiary of eHealth, Inc., is the leading provider of unbiased comparison tools and educational materials for Medicare Advantage, Medicare Part D Prescription Drug Plans, and Medicare Supplement insurance products. Seniors can take advantage of PlanPrescriber's free online advisor tools by logging on to, or by navigating to the Medicare sections of national pharmacy chain web sites, including Wal-Mart, Rite Aid, Kroger and others. PlanPrescriber helps Medicare recipients find a Medicare plan that covers their specific medical and prescription drug needs at the lowest possible out-of-pocket cost.

About eHealth

eHealth, Inc. (NASDAQ: EHTH) is the parent company of eHealthInsurance, the nation's leading online source of health insurance for individuals, families and small businesses. Through the company's website,, consumers can get quotes from leading health insurance carriers, compare plans side by side, and apply for and purchase health insurance. eHealthInsurance offers thousands of health plans underwritten by more than 180 of the nation's leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia, making it the ideal model of a successful, high-functioning health insurance exchange. Through its eCommerce On-Demand solution (eOD),, eHealth is also a leading provider of on-demand e-commerce software services. eHealth's eOD platform provides a suite of hosted solutions that enable health plan providers and resellers to market and distribute products online. eHealth's eCommerce On-Demand solution is currently available to health plan providers in all 50 states and the District of Columbia. eHealthInsurance and eHealth are registered trademarks of eHealthInsurance Services, Inc. eHealth, Inc. also provides powerful online and pharmacy-based tools to help seniors navigate Medicare health insurance options and choose the right plan through its wholly-owned subsidiary, PlanPrescriber ( PlanPrescriber's decision support tools are licensed to and incorporated into the websites and pharmacy counters of a number of major pharmacy chains and retailers. These pharmacy partnerships also drive high quality Medicare traffic to


Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare and provide Medicare Part A and Part B coverage. Medicare prescription drug coverage is insurance run by an insurance company or other private company approved by Medicare. A Medicare Supplement plan is a health insurance plan provided by a private company that fills in the "gaps" in original Medicare coverage.

Medicare has neither reviewed nor endorsed this information.

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