Healthcare reform and its effects on Medicare

Question:

Can you tell me if the new healthcare reform law affects Medicare?

Answer:

Yes, the new healthcare reform law does affect Medicare, and according to reports from the Centers for Medicaid and Medicare (CMS), the change is positive.

One of the most welcome changes brought about by the new health care reform law affects what’s known as the "donut hole" under the Medicare Prescription (Part D) benefit. Currently, if you’re enrolled in a Medicare Part D plan, once your plan has paid a set amount for your prescription drugs, you enter a Medicare coverage gap. That means that you must pay 100 percent of your prescription costs until you reach a certain threshold when the coverage kicks back in. For thousands of people, this "donut hole" means falling off a financial cliff or making another harrowing choice of not buying needed medications and waiting until a new year begins.

As of 2010, those NOT enrolled in the Medicare Extra Help program who reach the Medicare coverage gap ("donut hole") receive a one-time rebate check for $250 from Medicare. The Medicare rebate check is mailed directly to beneficiaries throughout the year soon after they reach the gap. It’s important to note that this benefit is automatic and there are no forms to fill out. So beware of scam artists who call asking you for private information so they can help you get your "$250 rebate check."

As of 2011, those who reach the coverage gap receive a 50 percent discount on all of their brand medications, and by 2020 there will no longer be a coverage gap in Prescription Part D programs. Between now and then, Medicare will continue to inform beneficiaries of discounts being offered to those reaching the coverage gap.

Here are some additional benefits you can expect with the new healthcare reform law:

As of January 2011, Medicare will cover an annual physical by your physician.
By 2014, at least 85 percent of every dollar spent by a Medicare Advantage plan must be spent on healthcare services rather than on administrative costs or insurance company profits.
A new voluntary long-term care insurance program (called Class Voluntary Long Term-Care Insurance or CLASS) has been created to help pay for long term-care in facilities and at home.
As of 2014, insurance companies will not be permitted to deny coverage to adults due to a pre-existing condition.

Another positive development is the passage of the Elder Justice Law as part of the Affordable Health Care Act. You can expect to see a much more aggressive program that identifies and prosecutes healthcare waste and fraud, along with more programs to address elder abuse and neglect.