Health Care Changes for 2011

Jan 05

My mother doesn’t have health insurance and I’m worried.

She is the director for a small daycare back home in North Carolina and unfortunately her employer cannot afford to provide health care coverage for its employees.  I, like so many Americans, have my eyes and ears glued to the news to hear the latest updates on what’s happening with health care reform.

On Monday, Jan. 3rd, Kaiser Health News provided a great, easy-to-read, outline of the nine ways the new health care law may affect us in 2011.

Here are some of the highlights from the list:

Insurance Rebates: According to Kaiser Health News, health insurers must spend at least 80 percent of their premiums on medical care or they face the possibility of giving rebates to consumers. Policies sold to large employers must hit an 85 percent spending target and self-insured employers are exempt. The article states the out of 75 million people who have insurance coverage under the rule; 9 million will be eligible for a rebate in 2012.

Lower prescription costs for seniors: Starting this month, drug companies will give seniors 50 percent off brand drugs. According to the National Council on Aging, the estimates savings under the new law could reach $1,800 for some seniors.

Calorie postings: Get ready to see calories next to the menu of your favorite meal the trend. Chain restaurants with 20 or more locations, and owners of 20 or more vending machines, will have to display calorie information on menus, menu boards and drive-thru signs. Restaurants must also provide diners with a brochure that includes detailed nutritional information, like the fat content of their dishes. The Food and Drug Administration is expected to finalize the rules for these changes this year.

Higher Medicare Premiums: Kaiser Health News reports the new health law will freeze the threshold for Medicare Part B, which covers physician and outpatient services, at the current level: incomes of $85,000 or above for individuals and $170,000 for couples. With this step, beneficiaries who pay higher premiums will rise from 2.4 million in 2011 to 7.8 million in 2019. Also, premiums for Medicare Part D, which covers prescription drugs, for the first time, will be linked to income. The thresholds will be the same as those for Part B and will not be linked to inflation. About 1.2 million beneficiaries will pay the income-related Part D premium this year, rising to 4.2 million beneficiaries in 2019.

Restrictions on medical savings accounts: The most notable hit to my wallet is the change in how I can use money from my flexible spending account, or pre-taxable income some employee’s set-aside for medical purchases. Starting this year, funds in this account can no longer be used on over-the-counter drugs, including drugs that treat fevers or allergies and acne, unless they have a doctor’s prescription. Also, starting this year, those with health reimbursement arrangements (HRAs) or Archer medical savings accounts (MSAs) accounts who spend money inappropriately will not only owe taxes on the money spent, but also face a tax penalty of 20 percent, which is double what it was. All pre-tax accounts, medical devices such as eyeglasses and crutches, and co-pays and deductibles will still qualify for use with the FSA, HRA and MSA accounts. Insulin obtained without a prescription is also eligible.

Bolstering seniors’ access to primary care: Medicare payments for primary care are going up by 10 percent from Jan. 1 through the end of 2015. Health practitioners will qualify for the bonus only if 60 percent or more of the services they provide are for primary care. General surgeons also will receive an increase if they are practicing in areas where there are doctor shortages. This portion of the health law is expected to expand coverage to 32 million more Americans by 2019.

Staying Healthy: According to Kaiser Health News, there are several provisions of the law that promote prevention of disease, especially for seniors, which is great news.  Starting January, Medicare enrollees will be able to get many preventive health services for free – such as vaccinations and cancer screenings. The law eliminates any cost-sharing such as copayments or deductibles for Medicare-covered preventive services that are recommended as well as any cost sharing for the “Welcome to Medicare” physical exam, which previously included a 20 percent co-pay.  For those people working for small employers, they will get some help, which is great news for my mom. The law authorizes the federal government to issue grants totaling $200 million for companies with fewer than 100 workers that start wellness programs focused on nutrition, smoking cessation, physical fitness and stress management.

Trimming Medicare Advantage: Private health plans that provide Medicare coverage will feel a squeeze under the new health law as payment for Medicare Advance plans is being restructured. Rates this year will be frozen at 2010 levels and lower rates will be phased in beginning in 2012.

Fighting hospital infections: According to a study by the Archives of Internal Medicine, about 1.7 million patients pick up life-threatening, but preventable infections, at the hospitals. In July, the federal government will stop paying for treatment of some hospital-acquired infections. The Medicare program for the elderly and disabled and many private insurers already ban payments for treating many of these infections.

I found this list to be extremely helpful in my efforts to understand all the new health care laws and what they’ll mean to my personal health care and my wallet.

What are your thoughts about the new health care laws for 2011?

This entry was posted on Wednesday, January 5th, 2011 at 1:24 pm and is filed under Public Health. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

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