Sunday, January 2, 2011

Happy New Year! New Health Law Changes In Effect.

With the start of 2011, a number of health law provisions are now in place. These include

1) Shrinking the "doughnut hole," meaning that seniors who fall into the doughnut hole (those who have spent between $2,840-$6,448 on medications, including what insurers pay) will now get a 50% discount on brand-name medications.  This compares to a $250 rebate they received in 2010.
2) Health insurers can use incentives (such as reduced premiums) for employees who join wellness programs or meet certain health targets. The discounts can be up to 30% of employee-related health insurance costs.  More info here.
3) Health insurance companies must now spend 80% (for small-group plans) on improving patient care, as opposed to spending on general profits/salaries, and admin costs.  If they fail to do so, they must give rebates to customers (starting in 2012).  This percent is 85% for large group plans.
4) Primary care physicians and general surgeons receive 10% more in reimbursements from Medicare.
5) Medicare will pay 100% of preventive care, meaning seniors on Medicare receive free health screenings (e.g. colorectal cancer, mammograms, etc) and other services (e.g. smoking cessation programs).
6) Medicare beneficiaries with annual incomes $85,000+ (for individual) or $170,000+ (for couples) will get smaller subsidies from Medicare Part D (prescription drug coverage)...and the start of higher premiums.
7) Holders of flexible-spending accounts will no longer be able to pay for most over-the-counter supplies with their accounts and will now require a prescription.
8) Community-Based Care Transition Program is underway, which is a Centers for Medicare and Medicaid Services (CMS) Demonstration project designed to put evidence-based care transition services into place for Medicare beneficiaries to reduce the risk of hospital readmissions and improve the quality of care for seniors.  Hospitals and community-based organizations apply to the Department of Health and Human Services to implement this program, based on other successful care transition models, which have eased the transition from hospital to home and reduced hospital re-admission rates.  More information found here.  .
9) Certified Nurse Midwives will now receive the same rate as physicians by Medicare.  They were previously only paid 65% of the physician rate.

Mandatory health insurance doesn't come into play until 2014.

For more information, check out: Kaiser Health News

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