Medicare

 

Medicare and the Donut Hole

 

The coverage gap, better known as the “Donut Hole” for Medicare Part D, starts after a beneficiary reaches the $2840.00 in prescription drug costs. The $2840.00 of drug cost is not representative of what the Medicare recipient pays, but is the total negotiated cost of the drug by a Medicare provider.  The Patient Protection and Affordability Act (ACA) of March 2010 gave rebates of $250.00 to persons that reached this mark.   Started in 2011, anyone reaching the $2840.00 of cost will receive a $50% and 7% discount on brand name and generic formulary drugs respectively.

 

With the Patient Protection and Affordability Act, (PPAA), the Nation’s first publicly funded long term care program was enacted. Through this program, after contributing to Medicare monthly for 5 years, a beneficiary would receive about $50/day to live at home rather than in a Nursing home.  Prior to the act, there was bias with Medicare and Medicaid that only entitled Medicare recipients to receive funds for long term care if they stayed at home.

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