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The Health Care Law and You

What the Health Care Law Means for People Age 65+

If you are 65 or older — or younger but on Medicare — the health care law may benefit you in several ways.

Lower out-of-pocket costs for prescription drugs

  • If you reach the doughnut hole, you will receive discounts on your prescriptions filled while you're in the gap: 50 percent on brand-name drugs and 7 percent on generics. How much you'll pay out of pocket for each drug may vary depending on your Part D plan, the prices your plan negotiated and how it has structured its gap coverage. These discounts will gradually increase until the Part D coverage gap disappears in 2020.

Strengthen Medicare

  • If you have Medicare, you qualify for a new annual wellness visit, mammograms and other screenings for cancer and diabetes — important preventive care at no charge.

  • Medicare Advantage plans that give better quality care will receive additional bonus payments. Plans must use some of this bonus money to offer you added health benefits.

  • New rules stop Medicare Advantage plans from charging people more than Original Medicare pays for certain services. These services include chemotherapy administration, renal dialysis and skilled nursing care.

Reduce waste, fraud and abuse 

  • The law cracks down on waste, fraud and abuse in Medicare and the health care system as a whole.

  • To guard against medical identity theft, the law also protects the privacy of your personal information.

Improve long-term care services and information

  • You have more information about nursing home inspections, complaints against facilities and consumer rights. This information will help you make decisions when selecting a nursing home.

  • Your state may 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 services to people with disabilities who live at home but need a higher level of care.

  • Starting in 2014, the law extends more financial protections to spouses of people on Medicaid. If you’re married to someone who receives Medicaid and gets long-term care services at home, you will have the same protections for your income and other resources as you would if your spouse lived in a nursing home.

Updated August 2012

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