Health Care Reform Provisions Impacting Senior
Citizens, Baby Boomers Start This Year
HealthReform.gov lists 18
provisions being activated this year; one targets baby boomers, two
senior citizens
April
16, 2010 – The Health and Human Services website to provide information
about the Health Care Reform Bill – HealthReform.gov – lists 18
provisions of the legislation that take “effect immediately.” Actually,
these provisions will be implemented in the first year. This includes
two that primarily impact senior citizens – demise of donut hole and
free preventive services, and one aimed at early retiring boomers.
The move to eliminate the donut hole in Medicare
Part D begins this year with a $250 rebate to Medicare beneficiaries who
fall into this “no coverage” zone of the prescription drug program in
2010. Next year they will receive a 50 percent discount on drugs when
they fall into the donut hole. By 2020 the dreaded donut hole will be
eliminated.
Another provision many seniors have cheered will
make preventive services – those exams that help catch problems early –
free. Starting January 1, 2011 co-payments will be eliminated and these
services will be exempted from deductibles in Medicare.
Another provision taking effect this year is
designed to help today’s baby boomers who have not yet reached age 65.
It creates a temporary re-insurance program to help offset the costs of
expensive insurance premiums for employers and early retirees age 55
through 64.
Key Provisions That Take Effect Immediately
1.
SMALL BUSINESS TAX CREDITS—Offers
tax credits to small businesses to make employee coverage more
affordable. Tax credits of up to 35 percent of premiums will be
available to firms that choose to offer coverage. Effective
beginning calendar year 2010. (Beginning in 2014, the small
business tax credits will cover 50 percent of premiums.)
2.NO
DISCRIMINATION AGAINST CHILDREN WITH PRE-EXISTING CONDITIONS—Prohibits
new health plans in all markets plus grandfathered group health plans
from denying coverage to children with pre‐existing
conditions. Effective 6 months after enactment. (Beginning in
2014, this prohibition would apply to all persons.)
3.
HELP FOR UNINSURED AMERICANS WITH PRE-EXISTING CONDITIONS UNTIL EXCHANGE
IS AVAILABLE (INTERIM HIGH‐RISK
POOL)—Provides
access to affordable insurance for Americans who are uninsured because
of a pre‐existing
condition through a temporary subsidized high‐risk
pool. Effective in 2010.
4.
ENDS RESCISSIONS—Bans
insurance companies from dropping people from coverage when they get
sick. Effective 6 months after enactment.
5.
BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE—Provides
a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010.
Effective for calendar year 2010. (Beginning in 2011, institutes
a 50% discount on prescription drugs in the donut hole; also completely
closes the donut hole by 2020.)
6.FREE
PREVENTIVE CARE UNDER MEDICARE—Eliminates
co-payments
for preventive services and exempts preventive services from deductibles
under the Medicare program. Effective beginning January 1, 2011.
7.
EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS’
INSURANCE—Requires
new health plans and certain grandfathered plans to allow young people
up to their 26th birthday to remain on their parents’ insurance policy,
at the parents’ choice. Effective 6 months after enactment.
8.
HELP FOR EARLY RETIREES—Creates
a temporary re-insurance
program (until the Exchanges are available) to help offset the costs of
expensive premiums for employers and retirees for health benefits for
retirees age 55‐64.Effective in 2010.
9.
BANS LIFETIME LIMITS ON COVERAGE—Prohibits
health insurance companies from placing lifetime caps on coverage.
Effective 6 months after enactment.
10.
BANS RESTRICTIVE ANNUAL LIMITS ON COVERAGE—Tightly
restricts the use of annual limits to ensure access to needed care in
all new plans and grandfathered group health plans. These tight
restrictions will be defined by HHS. Effective 6 months after
enactment. (Beginning in 2014, the use of any annual limits would
be prohibited for all new plans and grandfathered group health plans.)
11.
FREE PREVENTIVE CARE UNDER NEW PRIVATE PLANS—Requires
new private plans to cover preventive services with no co‐payments
and with preventive services being exempt from deductibles.
Effective 6 months after enactment.
12.
NEW, INDEPENDENT APPEALS PROCESS—Ensures
consumers in new plans have access to an effective internal and external
appeals process to appeal decisions by their health insurance plan.
Effective 6 months after enactment.
13.
ENSURES VALUE FOR PREMIUM PAYMENTS—Requires
plans in the individual and small group market to spend 80 percent of
premium dollars on medical services, and plans in the large group market
to spend 85 percent. Insurers that do not meet these thresholds must
provide rebates to policyholders. Effective on January 1, 2011.
14.
COMMUNITY HEALTH CENTERS—Increases
funding for Community Health Centers to allow for nearly a doubling of
the number of patients seen by the centers over the next 5 years.
Effective beginning in fiscal year 2011.
15.
INCREASES THE NUMBER OF PRIMARY CARE PRACTITIONERS—Provides
new investments to increase the number of primary care practitioners,
including doctors, nurses, nurse practitioners, and physician
assistants. Effective beginning in fiscal year 2011.
16.
PROHIBITS DISCRIMINATION BASED ON SALARY—Prohibits
new group health plans from establishing any eligibility rules for
health care coverage that have the effect of discriminating in favor of
higher wage employees. Effective 6 months after enactment.
17.
HEALTH INSURANCE CONSUMER INFORMATION—Provides
aid to states in establishing offices of health insurance consumer
assistance in order to help individuals with the filing of complaints
and appeals. Effective beginning in fiscal year 2010.
18.
HOLDS INSURANCE COMPANIES ACCOUNTABLE FOR UNREASONABLE RATE HIKES—Creates
a grant program to support States in requiring health insurance
companies to submit justification for all requested premium increases,
and insurance companies with excessive or unjustified premium exchanges
may not be able to participate in the new Health Insurance Exchanges.
Starting in plan year 2011.
>> More about Health
Care Reform on SeniorJournal.com
(Health Reform Section)
April
16, 2010 – The Health and Human Services website to provide information
about the Health Care Reform Bill – HealthReform.gov – lists 18
provisions of the legislation that take “effect immediately.” Actually,
these provisions will be implemented in the first year. This includes
two that primarily impact senior citizens – demise of donut hole and
free preventive services, and one aimed at early retiring boomers.
'...spouses of people receiving home care on Medicaid
will no longer have to be forced down into poverty before they get help'
Various online sources trying to provide seniors
information on health reform legislation