Health Care Reform Benefits: What 2011 Will Bring

Q. What are the new health care reform benefits that start in the new year? Do the recent court cases stop the changes?

A. So far, the court challenges to the law do not affect the benefits that began Jan. 1. Once the benefits kick in, health care policy experts and political experts predict it will be difficult to take them away. Because there are so many new benefits for this year, here are some highlights with links to past columns for more details.

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Medicare

If you have Medicare and a prescription drug plan, the coverage gap, or doughnut hole — when you have to pay the full cost of your drugs — is smaller this year:

• You get a 50 percent discount on brand-name and biologic prescription drugs that you buy in the gap.

• Generic prescription drugs get a 7 percent price cut starting in 2011.
  
  

People with Medicare also get free annual physical exams and free preventive health care benefits like cancer screenings. Stop-smoking counseling is also free this year, and available to all those on Medicare, whether or not they have symptoms of tobacco-related diseases.

Employer coverage or individual plans

People with employer-sponsored health coverage or individually purchased plans that renewed or started Jan. 1 are seeing these changes, which apply to all policies:

• Young adults can remain on or return to their family health coverage until their 26th birthday. (This does not apply to employer-sponsored retiree-only plans, however.) Watch for a written notice from your insurance plan or employer that describes at least a 30-day period when you can add your children to your policy.

• If you become sick, plans can no longer cancel your coverage because you have made an unintentional mistake on your application for insurance.

• Plans cannot set lifetime dollar limits on coverage. If your insurance was canceled because you reached your plan's limit, you will be able to rejoin the plan.
  
  

Exemptions and exceptions

Several different types of plans are not required to include all provisions of the health care law:

• Some new consumer protections and benefits are not required under grandfathered plans — those that were already in existence when health care reform became law. You will receive a notice from your insurer if your plan is grandfathered.

• Grandfathered plans can lose their exemption if they significantly reduce benefits or raise members' costs.

• There are also exceptions for retiree-only and medigap plans.
  
  

Preexisting conditions

If you have been unable to buy insurance for the past six months because of a preexisting condition, next year three new, less-expensive options will replace the Preexisting Conditions Insurance Plan the federal government runs in 23 states and the District of Columbia.

Find out more

To find out what changes health care reform will bring in the future, check out the Kaiser Family Foundation's interactive time line covering deadlines in 13 subject areas — from making health care more affordable to increasing long-term care options for older Americans.

Susan Jaffe of Washington, D.C., covers health and aging issues and writes the Bulletin’s weekly column, Health Care Reform Explained: Your Questions Answered.