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How Federal Health Reform is Helping Now

Published in the March 2011 of The Fifty Plus Advocate

At the end of January, we were gearing up for a major battle on Beacon Hill. Governor Patrick was readying the release of his 2012 state budget proposal. With a projected $1.8 billion shortfall, we worried how services for vulnerable seniors would be impacted, especially since they are already operating at bare bones.

While tough decisions were made, including troublesome cuts to adult day programs and protective services, Governor Patrick kept his promise to seniors and their families, level-funding most programs they count on, including home care.

The governor was also able to maintain the benefits of Prescription Advantage, the state’s pharmacy assistance program that works in tandem with Medicare Part D. It is a lifeline for almost 60,000 Bay State seniors who fall into the Medicare coverage gap – the dreaded doughnut hole – helping them to afford the medicine that keeps them healthy and out of more expensive care.

Although the budget proposal cut $9.8 million from the program, benefits remain the same. How, you ask? Thanks to the federal health care law – which is closing the Medicare doughnut hole.

According to AARP’s Rx Price Watch Report, the average annual cost for a brand name medication was about $1,400 in 2009. Starting this year, all seniors in the doughnut hole will receive a 50 percent discount for brand name drugs, and a 7 percent discount for generic drugs. These discounts will increase yearly until 2020, when the doughnut hole closes completely.

Bottom line: Federal health care reform is saving the state money on prescription drug assistance for seniors, enabling lawmakers to preserve Prescription Advantage while making life saving drugs more affordable for thousands of our most vulnerable citizens.

And, this savings couldn’t have come at a better time – as the state, and families, continue to struggle to make ends meet.

There’s much partisan bickering right now about health care reform. But, in Massachusetts, we see its positive impact at the state level, and now we’re seeing benefits from the federal law, too.

Today, federal health reform is working to strengthen Medicare. If you’re on Medicare, you qualify for a new annual wellness visit, mammograms, and other screenings for cancer and diabetes – important preventative care, now at no charge. And, if you’re on a Medicare Advantage plan, you can no longer be charged more than those on Original Medicare for services, like chemotherapy administration, renal dialysis, and skilled nursing care. Further, those Medicare Advantage plans that give better quality care receive additional bonus payments; some of this money must be used to offer you added health benefits.

If you have loved ones in a nursing home, it is now easier to file complaints about the quality of care, and get better access to information on nursing home quality and residents rights.

The law is also at work helping to protect early retirees. If you’re between the ages of 55 and 64 and have retiree health coverage through your work, new federal funds encourage your employer to continue offering health benefits until you become eligible for Medicare.

The new law helps protect your children. If your plan covers dependents and your adult children do not have employer-sponsored insurance, you can include them on your policy until they turn 26. And, children under age 19 who have pre-existing conditions cannot be denied coverage.

People with new insurance plans also have access to free preventative care such as mammograms, immunizations, and screenings for cancer and diabetes.

For everyone, federal health care reform improves insurance company practices. They can no longer drop your coverage if you become sick; your health insurance is guaranteed, as long as you pay your premiums. And they can no longer place lifetime limits on your health coverage. This change will ensure that your benefits do not run out when you need them the most.

Still to come: If you want to plan for your long-term care needs, beginning as early as next year, you will be able to participate in a voluntary national insurance program to help you pay for future long-term care services and supports. The program will be available to all working adults.

In 2014, more benefits from the health reform law will take effect. Improvements to insurance practices continue, and insurance companies can no longer deny health coverage because of a pre-existing condition. And, they cannot put annual limits on health coverage.

At AARP, we want you to have the facts about health reform so that you can make the best decisions for yourself and your family. Visit our website for more information – and to ask the experts any questions you may have.

Deborah Banda is the state director of AARP Massachusetts, which serves more than 800,000 members age 50 and over in the Bay State. This editorial appears in the March 2011 edition of The Fifty Plus Advocate, the statewide mature market newspaper.

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