| Medicare and the New Health Care Law |
|
Overview The Affordable Care Act has been designed to provide you and your family greater savings and increased quality health care. It will also ensure accountability throughout the health care system so that you, your family, and your doctors -- not insurance companies -- have greater control over your care. Your guaranteed Medicare benefits won't change -- whether you get them through Original Medicare or a Medicare Advantage Plan. Instead, you will see new benefits and cost savings, and an increased focus on quality to ensure that you get the care you need. During open enrollment this fall, you will continue to have a choice between Original Medicare and a Medicare Advantage plan. Medicare will continue to cover your health costs the way it always has, and there are no changes in eligibility. More Affordable Prescription DrugsBeginning January 2011, if you reach the coverage gap (commonly known as the "donut hole"), you will receive a 50% discount for covered brand name drugs and a 7% discount for covered generic drugs. You enter the donut hole when both you and your insurance company have spent $2,840 for covered drugs. The $2,840 threshhold does not include any premium payments, deductibles, or drugs not covered by your plan or drugs purchased from a pharmacy not in your plan's network. Over the next ten years, you will receive additional savings until the coverage gap is completely closed in 2020. Beginning in 2020, your coinsurance will be 25% for both brand name and generic drugs after your initial coverage benefits are exhausted. New Preventive Benefits to Help you Stay Healthy Beginning in January 2011, you can get free preventive care services like colorectal cancer screening and mammograms. You can also get a free annual physical to develop and update your personal prevention plan based on current health needs. This means Medicare will begin to cover two types of physical exams - one when you're new to Medicare and one each year thereafter. Your "Welcome to Medicare" physical exam is covered in full and is only available during the first 12 months of your Part B effective date. This exam provides a one-time review of your health, education and counseling about preventive services, and referrals for other care if needed. Your yearly "Wellness" exam is covered in full once you've been covered by Part B for 12 months or more. Your yearly wellness exam is intended to develop or update a personalized prevention plan based on your current health and risk factors. Changes to Medicare Advantage Plans Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than Original Medicare. In 2011, Medicare Advantage plans will still receive the same amount of extra payments as they did in 2010. Beginning in 2012, the new law levels the paying field by gradually eliminating Medicare Advantage overpayments to insurance companies. Beginning in 2014, the new law protects Medicare Advantage members by taking strong steps to ensure that at least 85% of every dollar these plans receive is spent on health care rather than administrative costs and insurance company profits. |
