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TRI-COUNTY AREA
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New health care changes are in effect

TRI-COUNTY AREA—Effective the start of this year, certain aspects of President Barack Obama’s health care reform law are now in place.
Jeff Angell, ProAction aging services coordinator and insurance counselor, said there are a lot of misunderstandings about the health care reform law.
“Health care reform is not going to take anything away from Medicare. It has improved some benefits,” he said.
According to the U.S. House of Representatives, the following went into effect Jan. 1, 2011:
Provides a $250 rebate to those Medicare beneficiaries who hit the prescription cost coverage gap in 2010. According to HealthCare.gov the gap is when someone spends a total of $2,800 out of pocket and no longer gets help paying for prescriptions. Medicare offers coverage again when the person spends $4,550 out of pocket in one year. Beginning in January 2011, there is a 50 percent discount on prescription drugs for people in the coverage gap (commonly referred to as the “donut hole”). Also completely closes the coverage gap by 2020.
Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program.
Requires all health plans to put more of your premiums into your care, and less into profits, CEO pay, etc. This medical loss ratio requires plans in the individual market to spend 80 percent of premiums on medical services, and plans in the large group market to spend 85 percent. Insurers that don’t meet these thresholds must provide rebates to policyholders.
Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled.
Angell said before the change, people with Medicare Part D coverage paid 100 percent of prescription costs. Under the reform it was changed to 50 percent. He explained when someone entered this coverage gap they rarely spent enough to get to the next level of coverage. Angell explained the preventive services includes immunizations and screenings for cancer and diabetes.
He added there is also the New York State Bridge Program that lets people with preexisting conditions have access to insurance.

 

 

 



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