The New Healthcare Law and What It Means for You
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An overview of the key improvements within the new health care law. We realize there is, and will continue to be, a lot to talk about regarding the health care law. This powerpoint is a starting point to get you acquainted with the law and some of the key provisions.
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The New Healthcare Law and What It Means for You
- 1. <?xml version="1.0"?><AllQuestions /> <?xml version="1.0"?><AllAnswers /> <?xml version="1.0"?><Settings><answerBulletFormat>Numeric</answerBulletFormat><answerNowAutoInsert>No</answerNowAutoInsert><answerNowStyle>Explosion</answerNowStyle><answerNowText>Answer Now</answerNowText><chartColors>Use PowerPoint Color Scheme</chartColors><chartType>Horizontal</chartType><correctAnswerIndicator>Checkmark</correctAnswerIndicator><countdownAutoInsert>No</countdownAutoInsert><countdownSeconds>10</countdownSeconds><countdownSound>TicToc.wav</countdownSound><countdownStyle>Box</countdownStyle><gridAutoInsert>No</gridAutoInsert><gridFillStyle>Answered</gridFillStyle><gridFillColor>0,0,0</gridFillColor><gridOpacity>50%</gridOpacity><gridTextStyle>Keypad #</gridTextStyle><inputSource>Response Devices</inputSource><multipleResponseDivisor># of Responses</multipleResponseDivisor><participantsLeaderBoard>5</participantsLeaderBoard><percentageDecimalPlaces>0</percentageDecimalPlaces><responseCounterAutoInsert>No</responseCounterAutoInsert><responseCounterStyle>Oval</responseCounterStyle><responseCounterDisplayValue># of Votes Received</responseCounterDisplayValue><insertObjectUsingColor>Blue</insertObjectUsingColor><showResults>Yes</showResults><teamColors>User Defined</teamColors><teamIdentificationType>None</teamIdentificationType><teamScoringType>Voting pads only</teamScoringType><teamScoringDecimalPlaces>1</teamScoringDecimalPlaces><teamIdentificationItem></teamIdentificationItem><teamsLeaderBoard>5</teamsLeaderBoard><teamName1></teamName1><teamName2></teamName2><teamName3></teamName3><teamName4></teamName4><teamName5></teamName5><teamName6></teamName6><teamName7></teamName7><teamName8></teamName8><teamName9></teamName9><teamName10></teamName10><showControlBar>Slides with Get Feedback Objects</showControlBar><defaultCorrectPointValue>100</defaultCorrectPointValue><defaultIncorrectPointValue>0</defaultIncorrectPointValue><chartColor1>187,224,227</chartColor1><chartColor2>51,51,153</chartColor2><chartColor3>0,153,153</chartColor3><chartColor4>153,204,0</chartColor4><chartColor5>128,128,128</chartColor5><chartColor6>0,0,0</chartColor6><chartColor7>0,102,204</chartColor7><chartColor8>204,204,255</chartColor8><chartColor9>255,0,0</chartColor9><chartColor10>255,255,0</chartColor10><teamColor1>187,224,227</teamColor1><teamColor2>51,51,153</teamColor2><teamColor3>0,153,153</teamColor3><teamColor4>153,204,0</teamColor4><teamColor5>128,128,128</teamColor5><teamColor6>0,0,0</teamColor6><teamColor7>0,102,204</teamColor7><teamColor8>204,204,255</teamColor8><teamColor9>255,0,0</teamColor9><teamColor10>255,255,0</teamColor10><displayAnswerImagesDuringVote>Yes</displayAnswerImagesDuringVote><displayAnswerImagesWithResponses>Yes</displayAnswerImagesWithResponses><displayAnswerTextDuringVote>Yes</displayAnswerTextDuringVote><displayAnswerTextWithResponses>Yes</displayAnswerTextWithResponses><questionSlideID></questionSlideID><controlBarState>Expanded</controlBarState><isGridColorKnownColor>True</isGridColorKnownColor><gridColorName>Yellow</gridColorName><AutoRec></AutoRec><AutoRecTimeIntrvl></AutoRecTimeIntrvl><chartVotesView>Percentage</chartVotesView></Settings> The Health Care Law: Changes & Improvements
- 2. Welcome 2
- 4. People with health insurance
- 7. People planning for their long-term care www.aarp.org/getthefacts 3
- 9. People with Health Insurance Things You Need to Know 5
- 11. You can’t be charged excessive premiums because of age, gender or health condition
- 12. Children under age 19 can’t be denied coverage for a pre-existing condition6
- 15. Covers more preventive care
- 16. Mammograms
- 17. Immunizations
- 18. Screenings for cancer or diabetes 8
- 19. People Who Are Uninsured Or Buy Their Own Coverage Things You Need to Know 9
- 21. Offers health insurance plans by 201410
- 23. Medical
- 24. Mental health
- 28. Tax credits available in 2014
- 29. Income limits:
- 31. $58,000 couple12
- 33. Adult children can be covered even if they:
- 34. Live with you
- 35. Are married
- 36. Are no longer in school13
- 38. Your plan must offer family coverage
- 39. If your adult children can get other coverage, you can’t add them to your plan14
- 41. Funded by federal government and states
- 42. Covers children, older persons, and disabled persons 15
- 44. Income limits:
- 46. $20,000 couple16
- 48. You must be uninsured for at least 6 months and have a pre-existing health condition
- 49. Accepted on a first-come, first-served basiswww.pcip.gov 17
- 51. Covers pre-existing conditions
- 52. Ends when exchanges start in 2014www.pcip.gov 18
- 53. 19 www.pcip.gov
- 54. Small Business Owners Things You Need to Know 20
- 56. Exchanges will offer a range of health plans
- 57. Businesses with more than 50 employees may pay a penalty if they do not offer coverage21 More options to offer employees
- 59. Must have 25 or fewer employees with average wages under $50,000
- 60. Must pay at least 50% of cost of insuring employees www.IRS.gov www.smallbusinessmajority.org 22
- 62. Starting 2011, can offer “simple cafeteria” plans
- 63. Helps employees save for future medical expenses
- 64. Grants for wellness programs
- 65. $200 million available starting 2011
- 66. Administered by US Dept. of Health & Human Services23
- 67. People Who Are on Medicare Things You Need to Know 24
- 70. Lowers out-of-pocket costs for prescription drugs 25
- 71. Medicare Drug Coverage Initial Benefit Catastrophic Benefit Doughnut Hole 50% discount for Brand Name and 7% for Generic You pay: Deductible and 25% of drug costs You pay: 5% of drug costs
- 73. By 2020:
- 74. Coverage gap will disappear
- 77. $85,000 for a single person
- 78. $170,000 for married couples
- 79. Will apply to those who have Part D drug coverage in 2011
- 81. Expands coverage for preventive care in 2011
- 82. No copayments or deductibles for Medicare-approved preventive care, starting 2011Call Medicare at 1-800-633-4227 www.medicare.gov
- 83. People Planning for Long-Term Care Things You Need to Know 31
- 87. Paid into the program for at least 5 years
- 90. Open to all working adults 18 or older
- 91. You will be enrolled unless you opt out
- 92. Premiums paid through payroll deductionswww.aarp.org/getthefacts 34
- 94. Your employer doesn’t participate
- 95. You are self-employed
- 96. You have more than one employerwww.aarp.org/getthefacts 35
- 98. Makes it easier to file complaints
- 99. Extends financial protectionswww.medicare.gov/NHcompare 36
- 100. 37
- 103. Creates new programs to help you get long-term care services
- 104. Offers new benefits for small businesses38
- 108. www.healthcare.gov
- 109. Medicare
- 110. 1-800-633-4227
- 111. www.medicare.gov
- 112. Insurance plans in your state
- 113. www.SHIPtalk.org - State Health Insurance Assistance Program
- 114. www.naic.org - National Association of Insurance Commissioners39
- 115. 40 www.shiptalk.org
- 116. 41 http://naic.org
- 117. 42 Has the Health Care Law helped you? Share your personal story www.capitolconnect.com/aarp-sys/
- 119. Jennifer CreaseyAssociate State DirectorAARP Illinois 300 W. Edwards Springfield, IL 62704 217-747-8883 jcreasey@aarp.org
Notas del editor
- Welcome to this webinar on “The Health Care Law: Changes and Improvements.”
- If you are like many people, you may have questions about what the health care law means for you. Some of the improvements and changes in the law are in effect now. Others will phase in over several years. By understanding what is in the law, you can make the best decisions for yourself and your family.
- During today’s webinar our AARP experts are going to give you an overview of the key improvements within the health care law. We realize there is, and will continue to be, a lot to talk about regarding the health care law. This webinar is a starting point to get you acquainted with the law and some of the key provisions. Here is what today’s session will cover: We will go over what the law means for several groups of people: Those who have insurance Those who do not have coverage or who buy coverage on their own Small business owners People with Medicare Those who are planning for their long-term care We will point out when the various provisions of the law go into effect , and Where you can go for more resources and information
- This is what the Get the Facts page looks like.If you look under “health care law resources,” you’ll find links to information about future webinars. You can also link to a collection of Fact Sheets about various aspects of the health care law.
- The first group we’re going to discuss are people who currently have health insurance. If you’re in this group, you may have been wondering how the health care law is going to affect you.
- First, the law makes a number of changes that protect you from discriminatory insurance practices. All of these are in effect right now.*For instance, as long as you continue to pay your premiums, health insurance companies cannot drop your health coverage if you become sick or disabled. There are also protections in place to make sure you are not charged excessive premiums because of your age, gender or health condition. Another important change is that children under age 19 cannot be denied health insurance because of a pre-existing condition, such as cancer, diabetes and heart disease. This provision will also extend to adults by 2014.
- The law also makes changes in the limits that an insurance company can place on your coverage. Before the law was passed, some insurers could limit how much they pay for your care during the year and over your lifetime. So, once your insurance coverage ran out, you would either have to pay out-of-pocket for all of your medical expenses, or go without medical care.Under the health care law, insurance companies will not be allowed to limit how much they will pay for medical benefits over your lifetime—giving you peace of mind that your benefits won’t run out when you need them the most. In addition, they won’t be allowed to limit how much they will pay for your medical benefits over the course of a year. The ban on lifetime limits is in effect now, and the ban on annual limits starts in 2014.
- Another change under the law is in the area of preventive health services. This year, for people with new insurance plans, you will no longer have to pay some of the out-of-pocket costs for preventive care, such as mammograms, immunizations and screenings for cancer or diabetes. Check with your insurance plan to see which of these services are covered at no cost to you.
- As we all know, there are many Americans who either do not have health insurance, or who have to buy their own insurance. ….. (and if you ever have to by insurance on your own, it can be pretty confusing to figure out how to compare plans and prices). Let’s look at how the health care law will affect this group.
- If you are uninsured or buy your own coverage, the health care law will make it easier for you to buy health insurance. If you’re an uninsured individual, or you own a small business, or you are self-employed, you will be able to purchase health insurance through state-based purchasing pools called “exchanges.” The exchanges must begin offering health insurance in every state by 2014.
- All health insurance plans in the exchanges will offer a standard set of comprehensive benefits. These include medical, mental health, prescription drug, and rehabilitation services. When insurance plans become available through the exchanges in 2014, you will be able to pick among several levels of coverage. Having standard benefits will make it easier for you to compare both health insurance plan benefits and costs.
- The law also provides some help for those who cannot afford coverage. In 2014, if you earn less than about $43,000 for an individual, or about $58,000 for a couple, you will get tax credits to help you pay your premiums for health insurance purchased through an exchange.
- As you know, among the uninsured group are many young adults who are no longer covered by a family policy or don’t have insurance through their job. In the past, young adults frequently were forced off their parents’ policies once they reached 18 or 21, or graduated from college. But, now, you may be able to cover your son or daughter on your insurance policy until they reach age 26. …(By the way, this is one of the first provisions to be implemented as a result of the health care law and I know a lot of parents and grandparents as well, are interested in knowing some of the details)…… If you currently have your children on your health insurance, you can keep them on your family policy until they reach 26—even if they no longer live with you, are married, and are no longer in school. You do not have to claim them as a dependent on your tax return. However, you will not be able to include their spouse or their children on your policy. If your adult children are not included on your health insurance now, and you want them to be—you will be able to add them to your policy -- if your insurer provides family coverage. Your insurance company should have sent you, or will be sending you, a written notice about how to enroll your adult child, if you qualify. However, if you’re adding adult children to your policy, their coverage may not begin until the start of your new insurance plan year.
- Here are some other important things you need to know about young adult coverage:Your insurance company will not be able to charge you more to insure your older children than they charge for younger children. And they can’t provide your older children with fewer benefits than your younger children.Insurance companies and employer-based plans are not required to offer family plans. If you are in a group plan that does not provide family coverage, you will not be able to include your adult children on your policy. Also, if your adult children have access to coverage through their jobs, you will not be able to add them to your plan. To be insured, they will have to take advantage of their employer’s health plan.So you will want to be sure to check with your insurance company or with your employer to see if your adult children can be included on your family policy.
- Another way the health care law helps uninsured people is by expanding the Medicaid program. …….And I am going to take a minute just to review what Medicaid is….. Medicaid is a health insurance program for low-income people that is jointly funded by the federal government and the states. It covers children, older persons, disabled persons, and others. Medicaid is required to cover low-income women with children. In some states, adults who do not have children can enroll in Medicaid. Other states do not allow adults without children to enroll in Medicaid, no matter how little they earn.
- But starting in 2014, you will be able to enroll in Medicaid, even if you are an adult who does not have children. You would need to meet the income limits which are currently about $15,000 a year for an individual and about $20,000 per year for a couple. Note that these figures will most likely change in 2014 when the Medicaid program expands.
- So what about people with pre-existing conditions? I mentioned a bit earlier….This year children under age 19 cannot be denied health insurance because of a pre-existing condition, such as cancer, diabetes and heart disease. And this will apply to adults by 2014.In the meantime, if you have been uninsured and have a pre-existing condition, you may be able to get temporary health insurance coverage. This coverage is often referred to as the “Pre-existing Condition Insurance Plan (PCIP).” Information about this coverage is available in your state now. To be eligible for the Pre-existing Condition Insurance Plan in your state, you must have been uninsured for at least6 months and have a pre-existing medical condition. It’s important to note that people who apply for this temporary coverage will be accepted on a first-come, first-served basis. We really encourage you to take advantage of this program, if you are eligible to do so.
- The Pre-existing Condition Insurance Plan covers a range of benefits, including primary and specialty care, hospital care and prescription drugs. In addition, all of these health plans must cover pre-existing medical conditions. Premiums will be based on a number of factors, such as your age, and the state where you live. The temporary coverage available through the Pre-Existing Condition Insurance Plans will end in January 2014 once the state-based health insurance exchanges begin offering coverage. For more information on the pre-existing condition insurance plan in your state visit www.pcip.gov.
- This is a screen shot of the pcip.gov website.To find information on Pre-Existing Condition Insurance Plan in your state, click on “Find Your State.”
- If you’re a small business owner, or know someone who is, you know that it can be a challenge to be able to offer health insurance to employees. Under the health care law, more choices will be available to small businesses. Some small businesses may also qualify for tax credits to offset part of the cost of insurance.
- Let’s start with finding health insurance for employees. Small businesses that do not currently offer employee health insurance will have more options in the future. Starting in 2014, businesses with up to 100 workers may be able to buy insurance for their employees through the new health insurance exchanges that Lisa mentioned earlier. The exchanges will offer a range of health plans to choose from. All of the plans sold through the exchanges must include standard benefits—such as medical, mental health, prescription drug, and rehabilitation services. What if you don’t offer employee health insurance? Will you be required to offer it? That depends on the number of people who work for you. If you have fewer than 50 employees, there will be no penalties for not offering health insurance. But as of 2014, businesses with more than 50 employees may have to pay an annual penalty if they do not offer coverage.
- Here’s some good news for small business owners: You may be able to get tax credits to offset part of the cost of offering health insurance to your employees. It’s estimated that 2.8 to 4 million small businesses will be eligible for the credits. The tax credits are retroactive to January 1, 2010. To be eligible for a tax credit:You must have 25 or fewer employees whose average annual wage is under $50,000,and You must pay for at least 50% of the cost of health care coverage for your employees. The amount of the tax credit depends on how many employees you have and their average wage. You can find more details about the small business tax credits by visiting the IRS website, www.irs.gov. Another helpful website is www.SmallBusinessMajority.org, where you can find a Healthcare Tax Credit Calculator and other useful information.
- There are two other benefits for small businesses that we want you to know about: The first has to do with cafeteria plans. Starting in this year (2011), businesses with up to 100 employees can offer what are called “simple cafeteria” plans. These plans allow employees to save part of their paycheck in an account that they can use to pay for future medical expenses. This saves your employees money because they do not have to pay taxes on the money they contribute to this account. The other benefit is the opportunity to apply for a wellness grant. The purpose of these grants is to help small businesses set up workplace wellness programs. Again, starting this year (2011), a total of 200 million dollars in grants will be available over a five-year period. The grants will be administered by the U.S. Department of Health and Human Services (HHS). As soon as information is available on how to apply, AARP will let you know.
- Let’s turn now to people with Medicare. What changes does the health care law have in store for this group?
- The law aims to improve Medicare by requiring Medicare to spend more wisely. If you have Medicare, your guaranteed Medicare benefits are protected. This includes doctor and hospital visits, and rehabilitation services. This is true whether you have Original Medicare, which includes Part A and Part B, or a Medicare Advantage plan. You will also receive improved benefits. For example, improvements to Medicare will lower your out-of-pocket costs for prescription drugs.
- Let’s take a minute to review the Medicare Part D Coverage Gap or Doughnut Hole. I know this can be confusing, so here’s a visual presentation of the doughnut hole that may be helpful. Starting on the left side, this is your initial benefit period where you pay your Part D deductible and about 25% of your drug costs. Moving to the middle, once you reach the initial coverage limit, you are in what is commonly called the "Coverage Gap” or "Doughnut Hole,". You reach the doughnut hole when you exceed a certain amount, which in 2011 is $2,840. What is new this year (2011), is that your plan will pay 50% of the cost of brand-name prescription drugs and 7% of your generic prescription drug costs while you are in the doughnut hole. This is a change that came about as a result of the health care law. By the way, exactly how much you pay out of pocket for each drug while you are in the doughnut hole will vary widely depending on the Part D plan you’ve chosen and the price your plan has negotiated with the companies that manufacture your drugs. Moving to the right side, when your total out-of-pocket expenses for drugs on your plan’s approved drug list reaches $4,550, you reach the "Catastrophic Coverage " benefit. From then until the end of the year, you pay roughly 5% of your drug costs under the catastrophic benefit. Just to clarify a bit …. your out of pocket costs include your deductible, copayments, and coinsurance. But this does not include your Part D premiums.
- In the past, you would have had to pay all of your prescription drug costs while you were in the doughnut hole. As we mentioned on the previous slide, if you reach the Medicare Part D doughnut hole this year, you’ll get a 50% discount on brand-name prescription drugs and a 7% discount on generic prescription drugs while you are in the coverage gap. This means you will no longer have to pay 100% of the cost of all your drugs while you are in the coverage gap. Depending on the drugs you take, you will be paying only half what you are paying this year.The gap will gradually narrow until it disappears in 2020. However, even after the gap is gone, everyone on Part D will still have the same level of cost sharing -- about 25% -- from the time you meet your deductible until the time you reach catastrophic coverage.Catastrophic coverage remains in place even after the coverage gap goes away. Catastrophic coverage starts when your total out-of-pocket drug costs have climbed to $4,550 in 2011. After that point, you only have a 5% co-payment.
- Starting today, you can use AARP’s Doughnut Hole Calculator to find out if or when you will hit the coverage gap and you’ll also find recommendations for less expensive drugs. When you click on the Doughnut Hole Calculator, you just enter your zip code and follow the steps. It’s easy to use and points you to ways to save right now on your drug costs. It’s at www.aarp.org/doughnuthole
- There is one more change related to Medicare that you need to know about. It has to do with premiums for people with higher incomes. As in prior years, you pay a higher monthly premium for Medicare Part B if your income is above a certain level.The income level starts at $85,000 for a single person or $170,000 for married couples filing joint tax returns.Starting this year (2011), income-related premiums will also apply to those who have Part D prescription drug coverage. The income levels for Part D are the same as those just mentioned for Part B -- $85,000 for an individualor $170,000 for married couples filing jointly.
- Starting this year (2011), you will no longer have to pay for Medicare-approved preventive care services. You will also be able to work with your doctor on a personalized prevention plan to keep you as healthy as possible. This means that health problems can be detected sooner and treated more quickly.These are just a few of the examples of the new free preventive benefits. They include:A free annual wellness visit. Screenings for diabetes and certain cancers. This includes mammograms, colonoscopies, and other preventive screenings.These new preventive services are in addition to the free “Welcome to Medicare” checkup available to every new person with Medicare during the first year of entering the Medicare program.The Secretary of Health & Human Services may also add other tests, screenings, or counseling, as we move forward in the future. You will not have to pay co-payments or deductibles for these Medicare-approved preventive care services.Screenings currently available, such as pap smears and prostate exams, will continue to be available.Call Medicare at 1-800-633-4227 or visit www.medicare.gov to see which of the Medicare-approved preventive care services are covered at no cost to you. Your copy of the booklet Medicare and You has a long list of all the preventive screenings now available. You can get the booklet by calling Medicare at 1-800-633-4227.If you are in a Medicare Advantage plan, check with your plan to see if you’ll have co-payments or deductibles for any screenings or tests.
- Many of us are concerned about planning for our long-term care. Not only for ourselves, but for our family as well.
- The law creates a new insurance program called CLASS, which stands for Community Living Assistance Services and Supports. You may have heard it referred to as the “CLASS Act.”CLASS is a voluntary national insurance program to help you pay for some of your future long-term care services and supports.
- The CLASS program will pay you a lifetime cash benefit if you paid into the program for at least five years, worked at least three of the initial five years you are enrolled, have a qualifying disability, and meet other eligibility criteria.
- How does CLASS work?All working adults, age 18 or older, will be able to enroll in the CLASS program. If your employer participates in the CLASS program, you will be enrolled automatically in the insurance through a payroll deduction, unless you choose not to participate.
- You still will be able to buy this insurance even if your employer doesn’t participate, if you are self-employed, or have more than one employer. The CLASS program will likely start in 2012 or 2013. Federal officials will provide additional details as the new insurance program is implemented. These include premium costs and the amount of cash benefits.Visit www.aarp.org/gethtefacts frequently for updates on the CLASS program and new law.
- Starting this year (2011), you will have easier access to more information on nursing homes to help you select a nursing home or monitor the care of a friend or a loved one. You will be able to get information about many things such as… who owns the nursing home, how much the nursing home spends on resident care compared to administrative costs, staff turn-over rates, and the number of complaints and violations. It will be easier to file complaints about the quality of care in a nursing home. Your state will be required to have a process in place to resolve complaints about nursing homes. The nursing home must notify you that your complaint has been received and how it has been resolved. Nursing homes in your state will have to meet new requirements if the facility closes. Residents and their families must be told of the closure far enough in advance so they can make other plans for relocation. If you are married to someone on Medicaid who is receiving care services at home, you will have the same protections for your income and other resources as do spouses of those on Medicaid who live in a nursing home. This provision starts in 2014.You will find more information on Medicare’s Nursing Home Compare website medicare.gov/NHcompare.
- On the Nursing Home Compare site, you can search by the name of the nursing home, or by city, county, state or ZIP code. That website is medicare.gov/NHcompare.
- There’s a lot to absorb about the health care law. Here are some key points to remember:The law : Increases consumer protections Makes health insurance more accessible and affordable—for individuals and for small businesses Improves and expands the benefits you receive under Medicare Creates new programs to help you get long-term care services in your own homeKeep in mind that the health care law will be phased in over a number of years. AARP will keep you informed as the various parts of the law go into effect.
- You are bound to have more questions as the health care law is implemented.AARP is working hard to provide you with updated information, so please visit aarp.org/getthefacts.Go to healthcare.gov for information on temporary insurance for pre-existing conditions and other aspects of the health care law.You can also find answers to your Medicare questions at medicare.govor by calling Medicare at (800) 633–4227. Finally, you can find insurance information for your state at SHIPtalk.org and at naic.org.
- At SHIPtalk.org, you can find contact information for SHIP in your state.
- And here’s a shot of the NAIC website. That stands for National Association of Insurance Commissioners. This site has links to the state insurance department for each state.
- Has the health care law helped you? If you have a story that you want to share, AARP is listening. We are collecting personal stories of people who have already benefited from the health care law. Personal stories illustrate how the law impacts our members and their loved ones. Your stories help us learn what is important to you, so we can continue to serve you and your family. Stories also help get the word out to the media, legislators, and other AARP members about the importance of quality, affordable health care.Your story may inspire others. www.capitolconnect.com/aarp-sys/
- Thank you for participating in today’s webinar. Goodbye!