The Affordable Care Act includes benefits to make your Medicare prescription drug coverage (Part D) more affordable. As of Jan. 1, if you reach the coverage gap (also known as the "doughnut hole") in your Medicare drug coverage, you will receive the following:

• A 50 percent discount on covered brand-name drugs when you buy them at a pharmacy or order them through the mail.
  
• Some coverage for generic drugs. You can expect additional savings on your brand-name and generic drugs during the coverage gap over the next 10 years, until the gap is closed in 2020.
  

Fact sheet available. Medicare has an informative fact sheet online. "Closing the Coverage Gap: More Prescription Drugs Are Becoming Affordable" fully explains the discount of brand-name drugs and coverage for generic drugs and how these benefits will increase over time. The publication is only available online, at www.medicare.gov. On the Web site, enter publication number 11493 in the "Search" area near the upper-right corner of the page.

What is the coverage gap and how will I know if I have reached it? Some Medicare drug plans have a coverage gap. This means that after you and your drug plan have spent a certain amount of money for covered drugs, you must pay the full cost of your prescription drugs, to a limit of $4,550 in out-of-pocket costs in 2011.

Every month in which you fill a prescription, your drug plans mail you an explanation-of-benefits notice, which tells you how much you have spent on covered drugs and whether you reached the coverage gap.

Who can get the new savings while in the coverage gap? As of Jan. 1, you can get the new savings if all of the following are true:

• You're currently enrolled in a Medicare Prescription Drug Plan (including employer group health and waiver plans) or a Medicare Advantage Plan that includes prescription drug coverage.
  
• You don't get Extra Help (a Medicare program to help people with limited income and resources pay for Medicare prescription drug costs).
  
• You have reached the coverage gap.
  

How does the 50 percent coverage gap discount work for brand-name drugs? Companies that make brand-name prescription drugs must sign agreements with Medicare to participate in the Medicare Coverage Gap Discount Program. This program requires the companies to offer discounts of brand-name drugs to people who have reached the coverage gap.

Starting in 2011, once you've reached the coverage gap you will automatically get a 50 percent discount on your brand-name prescription drugs when you buy them. The discount applies if you buy your prescriptions at a pharmacy or order them through the mail. The discount will come off of the price that your plan has set with the pharmacy for that specific drug. The entire price, including the 50 percent discount the drug company pays, will count toward the amount you need to qualify for catastrophic coverage. Once you reach the catastrophic coverage, you only pay a small co-insurance or co-payment for the rest of the year.

You will still need to pay any dispensing fees (the cost to fill a prescription).

How is coverage for generic drugs changing in the coverage gap? In 2011, Medicare will begin paying 7 percent of the price for generic drugs during the coverage gap. You will pay the remaining 93 percent of that price. What you pay for generic drugs during the coverage gap will decrease each year, until it reaches 25 percent in 2020. For generic drugs, only the amount you pay will count toward getting you out of the coverage gap. The dispensing fee is included as part of the cost of the drug.

What if I have other insurance? You can only get the discount if Medicare Part D is the primary payer (pays first) for your prescription drugs. If your other insurance coverage pays second, it will pay after the discount has been provided.

Get your questions answered.

• For more information about the closing of the coverage gap, call 800-633-4227 or visit www.medicare.gov. You may also contact your plan.
  
• For general information about Medicare prescription drug coverage, visit http://go.usa.gov/3GG to view the publication titled "Your Guide to Medicare Prescription Drug Coverage."
  
• For information on how to lower your prescription drug costs, visit http://go.usa.gov/loF to view the publication titled "Bridging the Coverage Gap."
• If you have limited income and resources, you may qualify for Medicare Extra Help on your prescription drug costs. Visit www.socialsecurity.gov or call 800-772-1213 to apply. TTY users should call 800-325-0778.
  
• Medicare beneficiaries in Johnson County may also receive information assistance through Senior Health Insurance Counseling for Kansas (SHICK) by calling 913-715-8856.