Health Reform: What Changes Are in Store for the Elderly?

After a year of legislative wrangling and premature forecasts of death, historic legislation overhauling the nation’s health insurance system has passed the Congress and been signed into law by President Obama. The measure that finally prevailed, the Patient Protection and Affordable Care Act, is the same legislation the Senate had approved on Christmas Eve of 2009, although it was amended somewhat by a separate “budget reconciliation” measure that President Obama also signed into law.

Because the core health reform measure enacted is the Senate version, much of what we wrote in our earlier article, “The Effects of Health Care Reform on Long-Term Care,” still applies. Just substitute “the newly enacted law” wherever “the Senate bill” appears in the earlier article. The legislation that President Obama signed still contains:

• The nation’s first publicly funded national long-term care insurance program, the Community Living Assistance Services and Supports (CLASS) Act. Its original sponsor, the late Sen. Edward M. Kennedy, did not live to see one of his legislative dreams enacted into law;
• A number of provisions aimed at ending Medicaid’s “institutional bias,” which forces elderly and disabled individuals in many states to move to nursing homes;
• Provisions that will help protect nursing home residents and other long-term care recipients from abuses, and give families of nursing home residents more information about the facilities their loved ones are living in or considering moving to; and
• The Elder Justice Act, which will establish an “Elder Justice Coordinating Council” and provide federal resources to support state and community efforts to fight elder abuse.

Help for Medicare Recipients and Early Retirees

Of perhaps greatest interest to seniors, the law will eventually close the Medicare Part D coverage gap known as the “doughnut hole.” As most seniors know, the Medicare Part D prescription drug program covers medications up to $2,830 a year (in 2010), and then stops until the beneficiary’s out-of-pocket spending reaches $4,550 in the year, when coverage begins again. Many seniors fall into this “doughnut hole” around Labor Day, at which point they have to pay for the medications out of pocket through the end of the year.

The law starts the process of closing the gap by providing a $250 rebate to Medicare beneficiaries who fall into the doughnut hole in 2010. Then, beginning in 2011 there will be a 50 percent discount on prescription drugs in the gap, and the gap will be closed completely by 2020, with beneficiaries covering only 25 percent of the cost of drugs up until they have spend so much on prescriptions that Medicare’s catastrophic coverage kicks in, at which point copayments drop to 5 percent.

For the rest of this piece, go to  http://www.elderlawanswers.com/resources/article.asp?id=8171&section=4

For the full text of the the Patient Protection and Affordable Care Act, click here.

For the full text of the Reconciliation Act of 2010, click here.