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The New Health Care Reform: Explaining Changes To Medicare Beneficiaries. On March 23, 2010, President Obama Signed Into Law THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. Followed Closely On Its Heels Was THE HEALTH CARE AND EDUCATION RECONCILATION ACT
Explaining Changes To Medicare Beneficiaries
President Obama Signed Into Law
THE PATIENT PROTECTION
AND AFFORDABLE CARE ACT
THE HEALTH CARE AND
EDUCATION RECONCILATION ACT
Signed Into Law March 30, 2010
These Pieces of Legislation
Current Health Care Reform
intensive lobbying, we now have
the most comprehensive change in
the American Health Care System since the
enactment of Medicare & Medicaid in 1965.
temporary provisions (effective 2010)
have been made to provide coverage for adults who have been excluded by insurers due to pre-existing conditions.
These pools will expire in 2014 when the pre-existing condition ban goes into effect.
Small Business Health Care Assistance
States will be required to set up Small Business
Health Plan Option Programs (SHOP) in which small business will be able to pool together to buy insurance
Small business are defined as no more than 100 employees – however states can limit SHOP to employers with 50 employees or less
Effective 2010 – Small business are provided with
federal tax credit until SHOP is implemented in 2014
provides a public, voluntary, long term program that working individuals can
The program would cover home care, respite care, home modifications,
transportation, and assistive technologies.
in a Number of Ways:
HEALTH CARE PROVIDERS:
how Reimbursements and Subsidies
are Determined and Dispersed
and the Benefit Services
they receive under Medicare
fall within the area of
Improving the Quality and Performance
of the Health Care System
and How do I Know
If I’ve Reached It?
Plan Pays 95%
Beneficiary Pays 5%
Beneficiary Pays 100%
Plan Pays 75%
Beneficiary pays 25%
Medicare Prescription Drug Plans (Medicare D Plans)
have a gap in coverage sometimes called the “Donut Hole”
During the Coverage Gap a beneficiary is responsible for
paying 100% of their drug costs.
For (2010) the Coverage Gap begins when the total cost for prescription drugs purchased through the plan reaches $2,830. The coverage gap ends when the individual’s own expenditures reaches $4,550.00.
About 390,00 Medicare Beneficiaries in Pennsylvania hit
the “Donut Hole” each year – the annual cost to individuals that reach the “donut hole “ averages over $4,000.
Qualied individuals will automatically receive their check from Medicare
an individual reached the
At the end of each quarter, all insurance companies that provide Prescription Drug plans will submit a report to Medicare listing every individual that has entered the Coverage Gap during that quarter
Rebate Check When I Should?
the US government web site
Managed by the Department
Of Health & Human Services
Continues to close the coverage gap by reducing the percentage of cost for beneficiaries.