Since the act was passed in March of this year, there has been a great deal of confusion with respect to what the Affordable Care Act actually means for Seniors. I have put together a time line that outlines some of the relevant changes and modifications affecting the Senior population.
March 2010: Insurance companies must now justify their premium increases to be eligible for $250 million in new grants. Insurance companies with excessive or unjustified premium increases may not be able to participate in the new health insurance Exchanges in 2014.
June 2010: As seniors reach the gap in Medicare prescription drug coverage, known more commonly as the “donut hole,” they will each receive a $250 rebate check.
July 2010: Residents of Florida who have a pre-existing condition and have been uninsured for at least 6 months, will be able to apply for coverage through the state’s pre-existing condition insurance plan program (PCIP) run by the U.S. Department of Health and Human Services(HHS). Benefits include: primary and specialty care, hospital care, and prescription drugs.
– Health plans beginning on or after September 23, 2010 MUST cover certain preventative services, such as mammograms and colonoscopies without charging a deductible, co-pay, or co-insurance.
– Rescission of coverage for technical errors or mistakes on insurance applications becomes illegal.
– Ability to appeal insurance company decisions via external review process becomes available.
– Lifetime dollar limits on essential benefits (such as hospital stays) are now prohibited.
– Use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted for new plans in the individual market and all group plans.
– 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.
– Seniors on Medicare become entitled to certain free preventive services, such as annual wellness visits and personalized prevention plans.
– The act gradually begins to eliminate Medicare Advantage overpayments to insurance companies. If you are in a Medicare Advantage plan, you will still receive guaranteed Medicare benefits.
– Health and Human Services (HHS) will submit national strategy for quality improvement in health care. The Center for Medicare & Medicaid Innovation will be established, and will begin testing new ways of delivering care to patients.
– Community Care Transitions Program will help high-risk Medicare beneficiaries who are hospitalized avoid unnecessary re-admissions by coordinating care and connecting patients to services in their communities.
– Independent Payment Advisory Board will begin operations to develop and submit proposals to Congress and the President aimed at extending the life of the Medicare Trust Fund.
– Community First Choice Option allows States to offer home and community based services to disabled individuals through Medicaid rather than institutional care in nursing homes.
– A voluntary long-term care insurance program called CLASS is created to provide cash benefits to adults who become disabled.
– A hospital Value-Based Purchasing program (VBP) in Original Medicare is established. This program offers financial incentives to hospitals to improve the quality of care. Hospital performance is required to be publicly reported, beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients’ perception of care.
– New funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost.
– States required to pay(Medicaid) primary care physicians no less than 100 percent of Medicare payment rates in 2013 and 2014 for primary care services.
– Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare. For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment.
– Americans who earn less than 133 percent of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid.
– Tax credits will become available for people with incomes above 100 percent and below 400 percent of poverty ($43,000 for an individual or $88,000 for a family of four in 2010) who are not eligible for or offered other affordable coverage.
– New plans and existing group plans are now prohibited from imposing annual dollar limits on the amount of coverage an individual may receive.
– Insurance companies are now prohibited from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. The act also eliminates the ability of insurance companies to charge higher rates due to gender or health status.
This is just a snapshot of a few of the changes we will be seeing in our health care coverage over the next several years. It will be interesting to see how the changes are implemented and whether or not they all accomplish the intended goals. For more information on the Affordable care act, please see the government’s website: www.healthcare.gov.