Thursday, December 9, 2010

Happy New Year! Health Reforms Come into Effect Jan. 1

Many of these provisions benefit seniors on Medicare, including free preventive care doctor appointments, reduced copayments for prescriptions, and improved follow-up care after a hospitalization.  Others are designed to reduce health care costs in Medicare and in private and small employer health plans.  By this date, the federal government must also submit a plan to improve healthcare quality for Medicare, Medicaid and CHIP enrollees.  Finally, any new health plan policy that began after March 23 is required to offer free preventive care services, without co-pays or deductibles, as soon as the new "policy year" begins.  For many policies, the renewal date is January 1. Check with your insurance provider or employer to verify whether these free services apply to you.


Prescription Drug Discounts

Seniors who reach the coverage gap will receive a 50 percent discount when buying Medicare Part D covered brand-name prescription drugs. Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020.


Free Preventive Care for Seniors

The law provides certain free preventive services, such as annual wellness visits and personalized prevention plans, for seniors on Medicare.


Improving Care for Seniors after They Leave the Hospital

The Community Care Transitions Program will help high-risk Medicare beneficiaries who are hospitalized avoid unnecessary readmissions by coordinating care and connecting patients to services in their communities.


Improving Health Care Quality and Efficiency

The law establishes a new Center for Medicare & Medicaid Innovation that will begin testing new ways of delivering care to patients. These new methods are expected to improve the quality of care and reduce the rate of growth in costs for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). By January 1, 2011, HHS will submit a national strategy for quality improvement in health care, including these programs.
Learn more about the Center for Medicare and Medicaid Innovation.


Addressing Overpayments to Big Insurance Companies and Strengthening Medicare Advantage

Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than is spent per person in Original Medicare. This results in increased premiums for all Medicare beneficiaries, including the 77 percent of beneficiaries who are not currently enrolled in a Medicare Advantage plan. The new law levels the playing field by gradually eliminating this discrepancy.  People enrolled in a Medicare Advantage plan will still receive all guaranteed Medicare benefits, and the law provides bonus payments to Medicare Advantage plans that provide high quality care.  Learn more about improvements to Medicare.


Bringing Down Health Care Premiums

To ensure premium dollars are spent primarily on health care, the new law generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement.  For plans sold to individuals and small employers, at least 80% of the premium must be spent on benefits and quality improvement. If insurance companies do not meet these goals because their administrative costs or profits are too high, they must provide rebates to consumers.Learn more about getting value for your health care dollars.

Providing Free Preventive Care

All new health plan policies must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance.

This part of the law is effective for people who enrolled in new job-related health plans or individual health insurance policies after March 23, 2010. If you have enrolled in a new health plan since that date, this provision will affect you as soon as your plan begins its first new “plan year” or “policy year” on or after September 23, 2010.  Since many health plans begin plan years on January 1, this is when this provision will go into effect for many people.

Learn more about preventive care benefits

This information is from

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