The Patient Protection and Affordable Care Act (PPACA), better known as “health care reform” and derided by some as “Obamacare,” passed into law with great fanfare last March. If you haven’t noticed any change in the health care system, that’s partly because most of the law’s provisions have yet to go into effect.
Many of the most important changes won’t happen until 2014, including the requirement that insurers cannot refuse to insure someone with pre-existing conditions. Let’s face it — by the time we reach 50, nearly all of us have “pre-existing conditions.” Our chances of being “pre-conditioned” go up as we age – mesothelioma, for example, is rarely diagnosed in patients younger than 50.
So we’ll have to wait a little longer for that benefit. A few of the law’s other provisions will kick in on January 1, however. Here are some changes that will affect people insured by a private insurance company or by Medicare:
PPACA puts a limit on the “minimum medical loss ratio,” which is a fancy name for the difference between what the insurer receives in premiums and what is paid out in benefits. Now, large group plans must spend at least 85% of premium income on benefits, and for small group and individual policies at least 80% of premium income must be paid out in benefits.
This ratio must be reported to the government, beginning January 1, and if an insurer doesn’t meet the ratio requirement, the insurer must give its customers a rebate.
Beginning January 1, the government is required to create a Community Living Assistance Services and Supports program. This will be a voluntary insurance program to provide benefits to pay for assisted living and long-term care when someone becomes disabled. Details of how the program will work and how people can sign up should be released later this year.
Several changes will affect Medicare — beginning January 1, pharmaceutical companies must provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap. Subsidies for generic prescriptions filled in the “gap” will be phased in beginning this year.
For those of you unfamiliar with the gap, also called the “doughnut hole” — previously, Part D benefits helped pay for annual prescription drug costs up to $2,700, but nothing above that. A catastrophic coverage program pays for nearly all yearly prescription drug bills over $6,154. But the costs in between $2,700 and $6,154 must be paid entirely by the Medicare recipient, which is a terrible burden. This year’s changes will bring some relief. The PPACA will close the gap entirely by 2020.
Beginning this year, doctors will get a 10 percent bonus payment for providing primary care services. Medicare also will give a 10 percent bonus to general surgeons working in areas with a shortage of doctors.
Some Medicare co-pays are eliminated, including co-pays for some preventive services and for colorectal cancer screening. Medicare also will pay for patients to receive a personalized disease prevention plan.
This entry was posted on Wednesday, December 29th, 2010 at 3:16 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
