Kansas Health Institute | Information For Policy Makers. Health for Kansans.

In the next few days, the state’s 415,000 Medicare beneficiaries will get a brochure in the mail from the government, letting them know how they’re likely to be affected by federal health reform.

And by mid June, those who have hit the so-called Medicare prescription drug coverage gap or “donut hole,” also will start receiving $250 checks.

Beginning June 10, the “donut hole” checks will start going out monthly, U.S. Health and Human Services Secretary Kathleen Sebelius said today at a Washington, D.C. press conference updating on the status of health reform’s soonest initiatives.

“Seniors do not need to do anything to receive this check,” Sebelius said. “They don’t have to sign anything. If they reach that donut hole, the checks will automatically be mailed.”

When do I get my check?

“That’s the question we get asked the most: ‘When am I going to get my check?’” said Suzie Lenker, director of the Senior Health Insurance Counseling For Kansas (SCHICK) program, which is administered by the Kansas Department on Aging:

The checks are expected to reach seniors the month after they hit the gap, or donut hole.

“Let’s say I just reached the donut hole today and I’m eligible – I don’t already receive the low-income subsidy,” Lenker said. “I would get my $250 check next month, in June – the second or third week in June. If I hit the donut hole in July, I’d get my check in August.

Lenker said each eligible beneficiary will receive only one check in only one month in 2010.

“This will not happen in 2011,” she said. “In 2011, instead of rebate checks, brand name prescription drugs are going to be discounted 50 percent.”

Currently, Medicare beneficiaries are expected to buy Part D insurance policies that cover 75 percent of their prescription drug costs up to $2,830. After they reach the $2,830 benchmark, they’re responsible for the next $3,610.

The gap in coverage – between the initial $2,830 and the $4,550 payout – is known as the donut hole. After a beneficiary reaches the S4,550, threshold, coverage returns for the rest of the year. On Jan, 1, the slate is wiped clean and the cycle repeats itself.

The federal health reform that became law two months ago, largely phases out the donut hole by 2020 and for this year provides seniors who hit it a $250 “rebate.”

Watching closely

“I know there are people out there who don’t think $250 is a big deal,” Lenker said, “but believe me this is something beneficiaries are watching very closely. An hour after the reform bill passed, I got a call from a beneficiary who wanted to know when the check was coming.

“And I get calls from caregivers who’ve maxed out every pot of money they’ve ever saved in their whole lives, trying to take care of a loved one,” she said. “They’re just looking for relief.”

The brochure trumpeting the checks and other benefits of health reform have been criticized by Republican opponents of health reform, including U.S. Sen. Pat Roberts of Kansas.

He called the brochure “...misleading, at best. At worst, I fear it could represent taxpayer-financed government propaganda.”

But HHS officials said the brochures provide needed information and will help protect seniors from scam artists who, according to Sebelius, have already become active, “in some jurisdictions,” trying to position themselves between seniors and the checks.

“We just got through sending out advance copies of the brochure to all our coordinators so they’ll have them in hand when people call,” Lenker said. “The fact of the matter is that (Medicare beneficiaries) are going to be gaining some very good benefits.

“Starting in 2011, for example, none of the preventive services will be subject to co-pays and deductibles,” she said. “They’ll be free and they’re adding a free, once-a-year wellness visit. That’s when they do things like check your cholesterol, do bone-mass measurements, assess your risk factors.”

By encouraging preventive care, CMS hopes to lower Medicare’s long-term costs, Lenker said.

Misleading?

On Wednesday, Roberts issued a press release accusing U.S. Department of Health and Humans Services Secretary Kathleen Sebelius of using the brochure to mislead the public about health reform.

Sebelius, a Democrat, is a former Kansas governor, insurance commissioner and legislator.

As HHS secretary, Sebelius is charged with overseeing CMS. Her name appears on the front of the brochure.

The Roberts’ press release included a copy of a May 26 letter he sent Sebelius, citing several conflicts between assurances in the brochure and concerns raised in an earlier analysis of the reform law done by the CMS chief actuary.

He asked Sebelius how much it cost to “produce and distribute’ the brochure.

Democrats aired similar complaints when the Bush administration mailed a flyer touting the benefits of the Medicare Part D drug benefit.

But Joe Baker, president of the Medicare Rights Center, which advocates for seniors, said Roberts’ criticisms were off the mark.

“The bottom line here, I think, is that the information that is going out from HHS is accurate,” he said. “There is nothing it the law that cuts (Medicare) benefits. There is nothing in the law that requires Medicare Advantage plans to cut benefits. The companies may decide to cut benefits on their own, but the law doesn’t require them to.”