Coming soon to a health care plan near you: The Health-Care Law Provisions Taking Effect in 2011

Change is scary but knowing what to expect helps. Check out the changes to our nation’s healthcare that will be in effect starting in 2011. Please note that most of the big stuff is happening in 2014. -SP

By Katherine Hobson
Parts of the uncatchily named Patient Protection and Affordable Care Act, aka the health-care overhaul law, began to kick in earlier this year. But in 2011, other provisions will roll out — some as soon as January 1.

The Kaiser Family Foundation counts 21 provisions taking effect next year. Among them:

-The requirement that the proportion of premium dollars spent on medical care must amount to at least 80% for small business plans and 85% for large group plans will kick in. The so-called medical loss ratio was the subject of discussion and lobbying this year as insurers jockeyed to meet the requirements — and to avoid paying consumers rebates if they don’t.
It’s the beginning of the end for the Medicare prescription-drug “doughnut hole.” Next year drug makers will provide a 50% discount on brand-name medications that fall into that coverage gap. Federal subsidies for generics will also begin.

-For Medicare beneficiaries, there will be no cost-sharing for certain preventive health services that receive an A or B rating from the U.S. Preventive Services Task Force.

-You won’t be able to pay for OTC drugs out of your flexible spending account, unless those drugs have been prescribed by a physician. (There are some exceptions.) We wrote recently about the change and how to figure out what’s eligible. The same applies to health reimbursement accounts.

-Calorie counts and other nutritional information will be posted on chain-restaurant menus and on food sold via vending machines.
The health-care overhaul law’s major provisions — such as the mandate that almost everyone purchase insurance, the requirement that insurers accept all comers and the establishment of state-based insurance exchanges — don’t take effect until 2014.

Click here to read the full article and the many helpful links at the Wall Street Journal online.

7 Tips for Picking a Medicare Part D Plan

AGE is hosting a special event this coming Saturday (11/13/2010) to help seniors and their families learn the ins-and-outs of Medicare for open enrollment. If you can’t make it to our event, check out this helpful article from US News -SP

7 Tips for Picking a Medicare Part D Plan
How to switch into a lower-cost prescription drug plan in 2011
By Emily Brandon

Beginning next week, Medicare Part D beneficiaries will have the opportunity to switch to a new prescription plan. Choosing a plan that covers your medications for a lower cost could save you hundreds of dollars in 2011. About 2.6 million beneficiaries enrolled in prescription drug plans will see a premium increase of at least $10 per month if they stay in their current plan. Current beneficiaries can choose a new Medicare Part D
plan between November 15 and December 31. Here are some important factors to consider when choosing among the Part D plans in your area:

Compare premiums. The average monthly Part D premium will be $40.72 in 2011 if beneficiaries remain in their current plan, which is up 10 percent from $36.90 in 2010, according to a Kaiser Family Foundation analysis. Average premiums vary considerably by location, ranging from $29.01 per month in New Mexico to $46.51 per month in Idaho and Utah. “We have seen plans that have had pretty substantial increases in premiums over the years,” says Jack Hoadley, a health policy analyst at Georgetown University’s Health Policy Institute. “What may have been the cheapest plan for you three or four years ago when you first signed up may not be good for you now.” For the first time, in 2011 there will additional premium increases for high-income retirees. Part D enrollees with annual incomes above $85,000 ($170,000 for couples) will have a monthly adjustment automatically deducted from their Social Security check. If that amount is more than the amount you receive from Social Security, you will get a bill from Medicare.

Read the full article here at US News and World Report’s website.

What Does Healthcare Reform Mean for You?

From the National Family Caregivers Association website

Family caregivers may be wondering what the newly signed Patient Protection and Affordable Care Act means to them and their loved ones.

The following is an overview of a few of the provisions of the new law that will take effect in 2010, as summarized by Patton Boggs, LLP, attorneys at law:

Immediate Access to Insurance for Uninsured Children and Adults with a Pre-Existing Condition. Provides eligible individuals access to coverage that does not impose any coverage exclusions for pre-existing health conditions. This provision ends when Exchanges are operational.

Prohibiting Rescissions. Prohibits abusive practices whereby health insurance companies rescind existing health insurance policies when a person gets sick as a way of avoiding covering the costs of enrollees’ healthcare needs.

Eliminating Lifetime Limits and Restricting Use of Annual Limits. Prohibits lifetime limits on benefits in all group health plans and in the individual market, and prohibits the use of restrictive annual limits.

Covering Preventive Health Services. All new group health plans and plans in the individual market must provide first dollar coverage for preventive services.

Extending Dependent Coverage. Requires any group health plan or plan in the individual market that provides dependent coverage for children to continue to make that coverage available up to age 26.

Improving Consumer Assistance. Requires that any new group health plan or new plan in the individual market implement an effective appeals process for coverage determinations and claims.

Rebates for the Medicare Part D “Donut Hole.” Provides a $250 rebate for all Part D enrollees who enter the “donut hole.” Currently, the coverage gap falls between $2,830 and $6,440 in total drug costs.

Strengthening the Healthcare Workforce. Expands and improves low-interest student loan programs, scholarships, and loan repayments for health students and professionals to increase and enhance the capacity of the workforce to meet patients’ healthcare needs.

New Study Shows What Americans Don’t Know About Long-Term Care

From the Right at Home website.

Most Americans know what long-term care is and how much it costs, but their scores fall short regarding how many people will need it and how they will pay for it. The MetLife Long-Term Care IQ Survey, taken by 1,021 individuals aged 40 to 70 in 2009, reveals that most are not taking appropriate steps to protect themselves from potentially catastrophic expenses.

According to the study:

-Just 36% of those surveyed know that 60%-70% of 65-year-olds will require long-term care services at some point in their lives.
-Just 37% know that most long-term care services are received at home.
-Older people (over 60) are more knowledgeable about long-term care than younger people (40 to 49).
-Only 45% are aware that one in five American households care for an adult family member or loved one.
-Few are taking action to protect themselves from such potentially catastrophic expenses; only 18% know long-term care insurance rates are based on age.
-87% are aware that a comprehensive long-term care policy covers home, assisted living and nursing home care.

Read more here at the Right at Home website.

Medicare’s Annual Open Enrollment is November 15 – December 31

From Right at

Help senior loved ones select a quality plan. The Medicare website offers tools to help compare supplemental ("Medigap") and prescription plans in your area. Download "Use Medicare's Information on Quality to Help You Compare" to learn more about things to look for.
The same percentage of Medicare beneficiaries who have access to a Medicare Advantage plan today (99.9 percent) will have access to a Medicare Advantage plan in 2010. In addition, all Medicare beneficiaries will have many prescription drug plans from which to choose.

The Centers for Medicare and Medicaid Services (CMS) encourages beneficiaries enrolled in Medicare Advantage and Medicare Prescription Drug plans to review their current health and drug plan coverage for any changes their plans may be making for 2010, before the annual enrollment period begins on November 15.

In 2010, beneficiaries who are currently enrolled in Medicare Advantage plans can expect to see an average premium of about $39 a month, a $7 difference from 2009. Medicare Prescription Drug plan premiums will average $30, a $2 difference from 2009. Those who qualify for the full Medicare low-income subsidy will pay no premiums or deductibles in Medicare Prescription Drug plans.

Read more here