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Some Health Care Reform Measures To Be Implemented This Year

Need help understanding the new health care law? You’re not alone. The law offers a number of benefits to Americans 50+. Some will be available this year and others will be phased in over the next several years.

“One of the immediate benefits of the new law is relief for seniors who’ve fallen into the Medicare prescription drug coverage gap where they’re paying 100 percent of the cost out of their own pockets,” said Stan Cooper, AARP New Mexico State Director.

Currently under the drug program, beneficiaries’ prescriptions are covered until they reach $2,830. They are not covered again until that figure reaches $6,440.

Under the new health care law, seniors enrolled in the Medicare prescription drug program this year who fall into the coverage gap, or “doughnut hole”, will receive an extra $250 to help pay their out of pocket costs. Seniors don’t have to do anything to receive their $250 check -- they will be mailed starting this summer.

The $250 one-time rebate is the first step toward closing the doughnut hole, which will ensure that no one is forced to pay an insurance premium and the full cost of their drugs.

Starting in 2011, seniors will get a 50 percent discount on all brand-name and biologic drugs they buy in the doughnut hole. Over ten years, they’ll gradually receive more discounts for generic drugs as well as brand name drugs until the gap completely closes by 2020.

Other benefits that will be available this year include:

  • Temporary insurance, also known as “high-risk pools” begins covering people who have a pre-existing condition and have been without insurance for the last six months.
  • Insurance companies can’t drop your coverage if you become sick    
  • Insurance companies can’t place lifetime limits on health coverage. They are also restricted from using arbitrary annual limits on your health coverage.
  • Employers providing retiree health insurance get funding to encourage continued coverage to early retirees.
  • Young adults up to age 26 can remain on their family’s health insurance plan.
  • Individuals with new employer-based or individual insurance plans do not have to pay a deductible and other out of pocket costs for certain preventive care services.

“This new health care law will help thousands of New Mexicans get and stay healthy by making health care coverage more affordable,” Cooper said.

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