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2011 Brings New Health Law Benefits

This year brings important new benefits under the Affordable Care Act (the new health care law), including for people in Medicare.

First, starting Jan. 1, 2011, you will get a 50 percent discount on brand-name prescription drugs and a 7 percent discount on generic prescription drugs while you are in the Medicare Part D coverage gap. Exactly how much you pay out-of-pocket will vary widely depending on the Part D plan you are in and the price your plan has negotiated. These discounts will increase until 2020 when you’ll no longer have to pay the full cost of drugs covered by your Medicare Part D plan.

If you have Medicare Part D, you may want to use AARP’s Doughnut Hole Calculator to estimate how much you’ll spend on drugs for the year. The calculator can also show you less expensive drugs in your plan.

Equally important, the new law expanded coverage for wellness and preventive care beginning Jan. 1. The health care law requires all new health plans to cover important preventive and wellness benefits with no deductibles and co-payments. Examples include services such as immunizations and screenings for cancer or diabetes.

Medicare will continue to cover a “Welcome to Medicare” physical exam for people who are new to the Medicare program. This free exam, which has no deductibles or copayments, is available during the first 12 months of enrollment into the Medicare program. Starting in 2011 Medicare will pay for an annual wellness visit and personalized prevention plan. The personalized prevention plan may include: assessment of health risks, updated medical history, and a screening schedule for appropriate preventive services for you to follow over the next 5-10 years.

Beyond Medicare, the new law also brings improvements to long-term care services. You will have access to more information about nursing home inspections, complaints against facilities and consumer rights. The new health care law provides nursing home residents with more protections from abuse, and it makes more information available about nursing homes so consumers can be better informed when selecting a nursing home, or monitoring the care of a loved one who resides in a nursing home.

States may also receive more funds to expand home- and community-based services. For example, under the Community First Choice Option, participating states get more federal dollars to provide home- and community-based attendant services and supports to people with disabilities who live in their homes and communities.

In addition, here are some of the ways the new law is helping your children and grandchildren.

As of Jan. 1, 2011, children up to age 19 cannot be denied coverage due to pre-existing health conditions. Additionally, certain preventive services will be covered with coinsurance or deductibles. Parents may keep a child on their insurance until the child’s 26th birthday.

Adults whom have a pre-existing condition or have been denied coverage because of a health condition, and who have been uninsured for a minimum of six months before applying, qualify for the federal Pre-Existing Condition Insurance Plan (PCIP) in their state. Learn more and apply online.

Find out more

Learn more about the Affordable Care Act. You’ll find numerous fact sheets specific to certain groups of people. You can also e-mail your questions about the new law to NewHealthCareLaw@aarp.org.

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