View Mobile Site

Text Size: Smaller Larger Normal

More On Medicare - Keeping Care Affordable

POSTED July 17, 2012 11:59 p.m.

In California, the Affordable Care Act – the new health care law – helped 1,327,883 people with original Medicare get at least one preventive service at no cost to them during the first six months of 2012, Health and Human Services Secretary Kathleen Sebelius recently announced. This is 45 percent of those eligible for these services in California. This figure also includes 109,444 in California who have taken advantage of the Annual Wellness Visit provided by the Affordable Care Act.

Nationwide, over 16 million with original Medicare received at least one preventive service at no cost to them so far in 2012, including 1.35 million who have had an Annual Wellness Visit. In 2011, 32.5 million people in Medicare received one or more preventive benefits free of charge.

Millions of Americans are getting cancer screenings, mammograms and other preventive services for free thanks to the health care law, Secretary Sebelius said. These new benefits, made possible through the health care law, are helping people stay healthy by giving them the tools they need to prevent health problems before they happen.

Prior to 2011, people with Medicare faced cost-sharing for many preventive benefits such as cancer screenings. Through the Affordable Care Act, preventive benefits are offered free of charge to beneficiaries, with no deductible or co-pay, so that cost is no longer a barrier for seniors who want to stay healthy and treat problems early.

The law also added an important new service for people with Medicare — an Annual Wellness Visit with the doctor of their choice— at no cost to beneficiaries.

For more information on Medicare-covered preventive services, please visit: http://www.healthcare.gov/law/features/65-older/medicare-preventive-services/index.html

To learn what screenings, vaccinations and other preventive services doctors recommend for you and those you care about, please visit the myhealthfinder tool at www.healthfinder.gov

Also, Secretary Sebelius reported that 1.9 million California residents will benefit from $73.9 million in rebates from insurance companies this summer, because of the Affordable Care Act’s 80/20 rule. These rebates will average $65 for the 1.1 million California families covered by a policy.

The health care law generally requires insurance companies to spend at least 80 percent of consumers’ premium dollars on medical care and quality improvement. Insurers can spend the remaining 20 percent on administrative costs, such as salaries, sales and advertising. Beginning this year, insurers must notify customers how much of their premiums have been spent on medical care and quality improvement.

Insurance companies that do not meet the 80/20 standard are required to provide their customers a rebate for the difference no later than August 1, 2012. The 80/20 rule is also known as the Medical Loss Ratio (MLR) standard.

Californians owed a rebate will see their value reflected in one of the following ways: a rebate check in the mail; a lump-sum reimbursement to the same account that is used to pay the premium if by credit card or debit card; a reduction in their future premiums; and their employer providing one of the above, or applying the rebate in a manner that benefits its employees.

Insurance companies that do not meet the 80/20 standard will send their policyholders a rebate for the difference no later than August 1, 2012. Consumers will also receive a notice from their insurance company informing them of the 80/20 rule, whether their company met the standard, and, if not, how much of a difference between what the insurer did or did not spend on medical care and quality improvement will be returned to them.

For the first time, all of this information will be publicly posted on HealthCare.gov this summer, allowing consumers to learn what value they’re getting for their premium dollars in their health plan.

For many consumers, the 80/20 rule motivated their plans to lower prices or improve their coverage to meet the standard. This is one of the ways the 80/20 rule is bringing value to consumers for their health care dollars.

David Sayen is Medicare’s regional administrator for California, Arizona, Nevada, Hawaii, and the Pacific Trust Territories. You can get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).

Most Popular Articles

There are no articles at this time.
Commenting is not available.

Commenting not available.

Please wait ...