The Health Care Law and You
The health care law enacted in 2010 brings a number of benefits to all Americans, including people over 50.
Some of these benefits you can get
right now. Others phase in over the
next few years.
If you buy health insurance on your own, have insurance through your employer, can’t get or afford insurance, or have Medicare, the health care law may affect you. By understanding what’s in the law, you can make better health care choices for you and your family.
The law:
• Makes discriminatory insurance practices a thing of the past
• Makes health insurance easier to get and more affordable
• Strengthens Medicare
• Helps with long-term care services
For All Americans: It is now easier for you to get and keep your health insurance. An insurance company must insure you even if you are or have been sick. Also, they can’t drop your coverage if you get sick. Protections are in place to limit increases to insurance premiums. Insurance companies must now justify any rate increase of 10% or more.
For People Who Are Uninsured: You now have access to health insurance even if you have a pre-existing condition. More people will be able to get Medicaid. Those without health insurance will be able to buy it through purchasing pools called exchanges. Many people will be able to get help to pay for their insurance.
For People with Medicare: Your guaranteed Medicare benefits are protected. Changes to Medicare lower the out-of-pocket cost for the prescription drugs you need to stay healthy. You also get more preventive care at no cost to you.
For People with Long-Term Care Needs: You have more information about the quality of care in nursing homes.
For Everyone
• Stops unfair insurance practices: Health insurance companies can no longer drop your health coverage if you become sick.
Your health insurance is guaranteed, as long as you continue to pay your premiums. Children under age 19 can’t be denied health insurance because of a pre-existing condition. In 2014, adults also can’t be denied health insurance because of a pre-existing condition.
• Stops lifetime and annual limits on coverage: Insurance com- panies can no longer place lifetime or annual dollar limits on your health coverage—giving you peace of mind that your benefits won’t run out when you need them the most. The ban on lifetime limits began in 2010, while the ban on annual limits begins in 2014.
• Requires coverage for preventive care: Most health insurance plans, including Medicare, now must cover proven preventive care such as immunizations and screenings for diabetes and certain cancers. This includes mammograms and colonoscopies.
These preventive services are at no out-of-pocket cost to you.
For People Who Are Uninsured or Buy Their Own Coverage
• Makes it easier to buy health insurance: Those without in- surance, small businesses and self-employed people can buy private health insurance through an exchange. An exchange is a state-run website where you can shop for and purchase coverage. Exchanges will make it easier to compare plan benefits and costs. Exchanges must begin offering insurance by 2014. If you are eligible for insurance through an exchange and do not purchase it, you will be subject to a penalty.
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• Creates standard benefits: All health insurance plans in the exchanges must offer a standard set of benefits including medical, mental health, prescription drug, and rehabilita- tion services. Standard benefits will make it easier to compare benefits and costs. You will be able to pick among several levels of coverage to fit your needs when these plans become available in 2014.
• Makes health coverage more affordable: Starting 2014, if you earn less than about $59,000 as a couple, or about $44,000 as an individual, you may be able to get tax credits to help you pay your premiums for health insurance purchased through an exchange. These figures, based on the 2011 federal poverty level, are subject to change. Higher income levels apply in Alaska and Hawaii.
• Expands eligibility for Medicaid: All children, parents, and adults without children who have less than about $15,000 in income, or about $21,000 for a couple, will be able to get Medicaid coverage starting in 2014. These figures are based on the 2011 federal poverty level and are subject to change. Higher income levels apply in Alaska and Hawaii.
• Covers people with pre-existing conditions: You may have access to coverage today if you have a pre-existing condi- tion, have been denied coverage because of your health, and have been uninsured for at least six months. A Pre-Existing Condition Insurance Plan (PCIP) is available in your state now.
This program continues until the exchanges start in 2014 when everyone will have more health plan options to choose from.
• Extends coverage for young adults: The law lets you include your children on your family insurance plan until they reach age 26. Be sure to check with your employer or health plan to see if they are eligible.
For People Who Have Medicare
• Lowers out-of-pocket prescription drug costs: If you reach the Medicare Part D coverage gap or “doughnut hole” in 2012, you will receive a 50% discount on your brand-name prescription drugs and a 14% discount on your generic drugs while you are in the coverage gap. The gap will gradually get smaller until it disappears in 2020. As long as you are enrolled in a Medicare Part D plan, you don’t need to do anything to get these benefits.
• Expands coverage for wellness and preventive care: You now get yearly wellness visits and other screenings for diabetes and certain cancers—at no cost to you. Be sure to make an appoint- ment with your primary care doctor to take advantage of these new Medicare-approved preventive services.
For People Planning For Long-Term Care
• Provides better information and accountability for nursing home care: It is now easier to file complaints about the quality of care in a nursing home. You also have access to more informa- tion on nursing home quality and resident rights.
• Extends financial protections to spouses of people on Medi caid: If you are married to someone on Medicaid who is receiving care services at home, you will have the same protections for your income and other resources as do spouses of those on Medicaid who live in a nursing home. Starts in 2014.
• Promotes independent living: Your state may receive financial incentives to provide greater access to the services and
supports you need to live independently in your own home and community.
Check www.aarp.org/getthefacts for the latest information about the health care law.
For personalized information about how the health care law works for you, go to www.aarp.org/healthlawguide.
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2014
• People with Medicare get a 52.5% discount on brand- name prescription drugs and a 28% discount on generic drugs while in the doughnut hole.
• Exchanges start offering health insurance coverage.
• Help is available for those with limited incomes who purchase health insurance through an exchange.
• More people will be able to get Medicaid.
• Insurance companies can’t put annual dollar limits on health coverage.
• Insurance companies can’t deny anyone health cover- age because of a pre-existing condition.
• Spouses of people on Medi- caid who get care services at home have the same income and other resource protec- tions as spouses of those on Medicaid who live in nursing homes.
2015
• People with Medicare get a 55% discount on brand-name prescription drugs and a 35%
discount on generic drugs while in the doughnut hole.
2016
• People with Medicare get a 55% discount on brand-name prescription drugs and a 42%
discount on generic drugs while in the doughnut hole.
2017
• People with Medicare get a 60% discount on brand-name prescription drugs and a 49%
discount on generic drugs while in the doughnut hole.
2018
• People with Medicare get a 65% discount on brand-name prescription drugs and a 56%
discount on generic drugs while in the doughnut hole.
2019
• People with Medicare get a 70% discount on brand-name prescription drugs and a 63%
discount on generic drugs while in the doughnut hole.
2020 - Doughnut Hole Closed!
Timeline
2010 – In Place Now!
• Temporary insurance, also known as the Pre-existing Condition Insurance Plan, covers people who have been denied insurance because of a pre-existing condition and have been without insurance for at least 6 months.
• Young adults up to age 26 may be able to stay on or be added to their family’s health insur- ance plan.
• Individuals with new
employer-based or individual insurance plans do not have to pay for certain preventive care services.
• Insurance companies can’t drop your coverage if you become sick.
• Insurance companies can’t place lifetime dollar limits on your health coverage.
• Children under age 19 can’t be denied health insurance because of a pre-existing condition.
2011 – In Place Now!
• People with Medicare get a 50% discount on brand-name prescription drugs and a 7%
discount on generic drugs while in the coverage gap or
“doughnut hole.”
• Medicare adds free coverage for wellness and preventive care.
• It’s easier to file complaints about the quality of care in a nursing home. Better access to information on nursing home quality and resident rights is available.
2012 – In Place Now!
• People with Medicare get a 50% discount on brand-name prescription drugs and a 14%
discount on generic drugs while in the doughnut hole.
2013
• People with Medicare get a 52.5% discount on brand- name prescription drugs and a 21% discount on generic drugs while in the doughnut hole.
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