Upcoming Health Care Reform Changes

March 1, 2013

This year many changes to the U.S. health care system went into effect. Next year more changes are coming and we have listed some important changes that will become effective January 1, 2011.

Prescription Drug Discounts

Seniors who reach the coverage gap will receive a 50 percent discount when buying Medicare Part D covered brand-name prescription drugs. Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020.


Free Preventive Care for Seniors
The law provides certain free preventive services, such as annual wellness visits and personalized prevention plans, for seniors on Medicare.

Managing Health Care Premiums
To ensure premium dollars are spent primarily on health care, the new law generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement.  For plans sold to individuals and small employers, at least 80% of the premium must be spent on benefits and quality improvement. If insurance companies do not meet these goals because their administrative costs or profits are too high, they must provide rebates to consumers.

Addressing Over-payments to Big Insurance Companies and Strengthening Medicare Advantage
Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than is spent per person in Original Medicare. This results in increased premiums for all Medicare beneficiaries, including the 77 percent of beneficiaries who are not currently enrolled in a Medicare Advantage plan. The new law levels the playing field by gradually eliminating this discrepancy.  People enrolled in a Medicare Advantage plan will still receive all guaranteed Medicare benefits, and the law provides bonus payments to Medicare Advantage plans that provide high quality care.

Improving Care for Seniors after They Leave the Hospital
The Community Care Transitions Program will help high-risk Medicare beneficiaries who are hospitalized avoid unnecessary re-admissions by coordinating care and connecting patients to services in their communities.

Post author Loren Pleet