We all hear quite a lot of negative rhetoric about the new health care reform bill by candidates running for office this year. For Medicare recipients, the new bill enacted earlier this year has many positive reforms that will not only help them financially but also could improve the quality of their lives. Right now, Medicare patients pay small co-pay for doctor office visits, along with larger co-pays, co-insurance and deductibles for many screening tests. Many seniors forego screening tests because they cannot afford the deductibles and copayments. Starting next year, the new bill provides free annual physicals and no deductibles, co-pays or co-insurance towards preventative measures such as colonoscopies, mammograms and immunizations. The insurer must pick up 100% of the bill. This can only help Medicare patients live a healthier life by encouraging early detection and treatment of possible medical problems. While health insurers, including Original Medicare and Medicare Advantage, would still have to cover screenings and possible treatments that serious illnesses require, their costs would be less over a shorter length of treatment time. For example, if a person is diagnosed in the early stages of cancer (Stage I breast cancer), treatment may include a lumpectomy and possibly radiation and/or chemotherapy. However, later stages of breast cancer may require a costlier radical mastectomy, and sometimes more than one round of radiation and chemotherapy.
The law will prohibit insurers, from denying health care due to pre-existing conditions, nor will they be able to establish a lifetime limit on benefits. The new bill includes a new law to help prevent elder abuse and neglect and improve nursing home care. It also creates a new voluntary insurance program to help pay for long-term care at home. The bill will reduce the amount of subsidy it pays to Medicare Advantage Plans. Right now, Medicare pays over $1,000.00 more per person to Medicare Advantage insurers than it pays per person to Original Medicare. The aim is to decrease Medicare costs and to ensure that at least 85% of every dollar paid to Medicare Advantage plans will be spent on health care and not insurance company profits.
Probably one of the most important aspects of health care reform affecting Medicare recipients is the eventual closing of the coverage gap, or doughnut hole, in the Medicare Part D Prescription Drug coverage. Until this year, Medicare Part D enrollees were required to pay full price for prescription medications once they and their Part D insurers together spent $2,850.00. Many medications being taken by Medicare patients do not have generic counterparts. Some may only cost $50 per month, while others can cost over $1,000.00 per month. If a patient is on a maintenance drug all year, many Part D insurers require the patient to order and pay for a three-month supply every quarter. Although the patient has a co-pay, and sometimes a deductible, the total cost of each medication is taken into consideration when applying the cost to the coverage limit of $2850.00. If someone does not have medical benefits through an employer, or if they do not qualify financially for state aid, more often than not, the patient will cut back on doses to conserve their medications.
The new law provides a one-time $250.00 rebate this year to Medicare Part D patients once they enter the coverage gap. In 2011, those who fall into the doughnut hole will receive a 50% discount on brand-name drugs. In subsequent years, those falling into the gap will receive additional savings until the gap is eliminated in 2020. It is important to make sure senior citizens take their medications properly to decrease the possibility of increased health problems or the worsening of an existing illness. For those citizens on Medicare, the new health care reform offers more benefits over time.