Answers to frequently asked questions about health care reform.
Will my benefits be cut if I am currently on Medicare?
No. The law does not cut your guaranteed Medicare Part A and Part B benefits. Beginning
in 2011, you will have some additional benefits, including Medicare-covered preventive
services at no cost.
However, government payments to Medicare Advantage – health plans that are
run by private insurers – will be reduced over the next decade. Some Medicare
Advantage plans offer added benefits that traditional Medicare does not offer. But
some of those benefits may change due to the reduction in government payments.
What is the Medicare prescription drug "doughnut hole," or coverage gap,
and does it affect me as a Medicare beneficiary?
In 2010, about 4 million beneficiaries will reach the doughnut hole, or coverage
gap, in Medicare prescription drug coverage once they spend $2,830 in prescription
drugs by the end of the year. Beneficiaries who reach the doughnut hole in 2010
will be given a $250 check by the government. Checks began going out to beneficiaries
in June 2010.
Beginning in 2011, the coinsurance for generic drugs for Medicare beneficiaries
who reach the doughnut hole will be 93 percent, compared to 100 percent this year.
They will also receive a 50-percent discount on brand-name drugs and biologics.
These discounts and out-of-pocket costs will count toward the catastrophic threshold
Over time, the health care reform law will shrink and eventually eliminate the doughnut
hole, and continue to phase out cost-sharing for brand-name and generic drugs.
When can I receive preventive care at no cost and what does it cover?
Beginning in Jan. 2011, Medicare-covered preventive services will be offered with
no cost-sharing. Detailed information will be available on the Medicare website. [www.medicare.gov].
Will Medicare cover adult dependents the same way private health plans do?
No. The provision that covers dependents up to age 26 does not apply to Medicare.
Do the benefit coverage requirements from the health care reform law apply to Medicare
and Medicare Advantage?
Medicare Advantage plans are required to offer Medicare Part A and Part B benefits.
Most Medicare Advantage plans also include Medicare prescription drug benefits.
These are not the same as the "essential benefits" required for individual
and small group health plans.
Does health care reform affect long-term care?
The new law creates a voluntary program called the Community Living Assistance Services
and Support (CLASS) Act to help pay for long-term care.
What is the reinsurance program for early retirees?
The early retiree reinsurance program is a new federal program for qualified employers
and unions. The program reimburses 80 percent of claims between $15,000 and $90,000
submitted by employers who provide health care coverage to retirees ages 55 through
64 who meet other specified conditions. The early retiree reinsurance program is
not applicable to Medicare-eligible recipients.
This information is based on HMSA’s review of the national health care reform
legislation. This overview is intended for educational purposes and should not be
used as tax, legal, or compliance advice. Interpretations of the legislation vary
and some reform regulations differ for particular members enrolled in certain groups.
HMSA will continue to present and update information related to national health
care reform as additional guidance becomes available.