Mississippi has a significant older population that will benefit from key provisions in the new health reform package. For example, 12.0 percent of the population is age 65 or older and 19.2 percent is age 50-64. The health reform package will strengthen and improve the Medicare program
Medicare is a sacred promise that was made to older Americans – because no one should be left to struggle with medical bills after a lifetime of hard work. In Mississippi, 440,000 people depend on Medicare for stable, affordable health care. And yet, because of skyrocketing health care costs and our current economic crisis, the program’s gaps are becoming more apparent.
The Health Reform Package:
- Improves access to primary care doctors: Your primary care doctor will receive bonuses for treating people in Medicare, helping to ensure that the 440,000 Medicare beneficiaries in Mississippi have continued access to important primary care services.
- Closes the Medicare Part D coverage gap or doughnut hole: In 2010, if you reach the doughnut hole, you will receive a rebate for $250 to help you pay for prescriptions. Beginning in 2011, if you reach the doughnut hole, you will receive a 50 percent discount on your brand-name drugs. The doughnut hole will be fully closed over the next 10 years.
- Provides preventive care, such as screenings for cancer and diabetes, free of charge: You will no longer have to pay out of pocket for preventive care services. You will also be able to work with your doctor to develop your own plan to keep you as healthy as possible.
- Improves the coordination of care for people with chronic health conditions: It begins a new program that provides benefits to help older Americans and people with disabilities stay in their own homes and communities.
Extending the solvency of Medicare: Health insurance reform will extend the life of the Medicare Trust Fund by nearly a decade.
Help With Prescription Drug Cost
Today, people in Medicare spend about 30 percent of their incomes, on average, on out-of-pocket health costs – including premiums for supplemental coverage. These costs are six times greater than for people with employer coverage. Skyrocketing drug costs are a particular problem for people in Medicare. In 2007, 30 percent of the Medicare beneficiaries in Mississippi fell into the Part D “doughnut hole,” or coverage gap, which meant that they had to pay the entire cost of their medication and their premiums.
The Health Reform Package:
- Offers a one-time $250 rebate for Part D enrollees who fall into the doughnut hole in 2010;
- Reduces brand name drug costs by 50 percent for enrollees in the doughnut hole starting in 2011; and
- Gradually closes the doughnut hole by reducing enrollees’ brand name and generic drug costs in the doughnut hole so that by 2020, enrollees will be responsible for 25 percent of their brand name and generic drug costs from the time they meet their deductible until they enter catastrophic coverage.
This could add up to savings of nearly $2,000 next year for Mississippians with high prescription drug spending.
Coverage More Affordable For 50 to 64-year-old Mississippians
As the baby boomers age, the ranks of people without health insurance age 50 to 64 are soaring. Mississippi has 90,000 people age 50-64 who are uninsured and another 54,000 people in that age group who buy coverage in the individual market.
The Health Reform Package:
- Creates new rules for insurance companies so that they can no longer discriminate against people who are sick, can no longer charge unaffordable rates based on age;
- Provides people with help purchasing coverage;
- Provides tax credits to small businesses to help make employee coverage more affordable; and
- Creates a temporary high-risk program for the uninsured with pre-existing conditions.
As many as 257,867 people age 50-64 in Mississippi may be eligible for a tax credit that helps make premiums affordable. Also, 85,479 lower income Mississippians in the same age group would qualify for even more protection from unaffordable health care costs through the state Medicaid program, with the federal government paying the entire cost for three years.
Long-Term Services and Supports at Home
As many as 99,990 Mississippians currently have a disability and need greater access to long-term services and supports (LTSS). The Community Living Assistance Services and Supports (CLASS) provision in the new law creates a new national voluntary insurance program that could help Mississippians with disabilities pay for the LTSS they need to remain independent in their homes and communities.
CLASS provides a cash benefit (with a minimum benefit averaging not less than $50/day) for eligible participants with qualifying disabilities. Benefits may be used to pay family caregivers. Individuals can participate in CLASS through automatic payroll deductions through their employer or they will also be able to enroll if their employer does not participate in CLASS. There is a 5-year vesting period and individuals must be working a certain amount at least three of those five years. As long as individuals remain eligible, there is no lifetime limit on the benefits that participants may receive.
In addition to benefiting individuals, the CLASS program could be an economic win for states in the longer-term as an individual’s participation could delay or prevent their need to access Medicaid long-term services and supports.
Even though 89 percent of individuals age 50+ wish to remain in their homes as long as possible, only 11% of Mississippi’s Medicaid long-term care spending for older people and adults with physical disabilities pays for HCBS. The new law offers new options and financial incentives to states to expand access to home- and community-based services. The Community First Choice Option would provide states with a 6 percent enhanced federal Medicaid match rate if they opt to provide certain HCBS to individuals with disabilities eligible for an institutional level of care.
The State Balancing Incentives Payments Program would provide grants to states in the form of a temporary enhanced federal Medicaid match rate of 5 percent or 2 percent (depending on a state’s level of Medicaid long-term services and supports spending on home- and community-based services) for states that make structural changes in their long-term services and supports systems to increase access to HCBS.
In addition, the new law makes improvements to the existing Medicaid HCBS state plan option to help encourage states to make use of this tool to expand access to HCBS.