Health care reform

On March 24 there were reports of people showing up at hospitals and doctors offices expecting free health care. They were expecting the free care, because the day before President Obama had signed into law the Patient Protection and Affordable Care Act (H.R. 3590). After all, these folks had been hearing about all of the benefits they were going to receive as a result of the reform in health care.

The bill was originally approved by the Senate on Dec. 24, 2009, and by the House on March 23, 2010. It was approved by Congress even though they had not read the bill and did not know what was included in it. Many of those same people that voted for passage are now surprised by some of the things that are included in it. This bill was passed in spite of the polls showing that a majority of citizens were opposed to it.

The other day, it was reported by one congresswoman that 90 percent of those contacting her, even after the passage of the bill, were opposed to the bill. Her comment was, "They don't get it."

The bill was pushed through Congress because it was essential to hurry up and get it done; even with the estimated cost not finalized. They throw around large sums of money as if it is not a big deal. Last week it was announced that the bill was going to cost a billion dollars more than they had originally estimated -- that might have been for the first 10 years. Still, a billion here and a billion there, it begins to add up to real money.

The health insurance companies appear to be positive about the changes that are being made. They are making efforts to interpret the bill and find out how it will be implemented and to give their full cooperation to it. (Do they have any other choice?)

According to information I received from one insurance company nominal cost sharing will be included in Medicare Supplement Plans C and F beginning in 2015. The portion, or how the cost sharing will be included, was not given. At this point I do not know if it is for Part A (hospitalization) or for Part B (medical) or both. As long as it is nominal, it may be a good thing. It will help to keep the premiums lower, but more importantly it might reduce the usage. As long as there is not any out-of-pocket cost, the attitude is use it, it doesn't cost anything.

Drastic cuts are being made in the Medicare Advantage Plans. These plans have been popular among the Medicare Advantage Plans. On the average many of the plans have saved the members $800 a year compared to being in original Medicare with a Medicare Supplement. $132 billion is being cut from these plans over the first 10 years. These cuts are being made due to the concerns that Medicare currently overpays these plans.

There are conservatives that think that the Medicare Part D prescriptions should not ever been enacted. Before Plan D became available there was not any help with prescriptions. On the average those on Plan D have saved 50 percent on their medications. There has been a gap, referred to as donut hole, when the Medicare beneficiaries have to pay for all of their medications. This is difficult for those on costly medications.

There is a benefit in the Affordable Care Act that is being implemented this year that will benefit some beneficiaries enrolled in a stand-alone PDP or a Medicare Advantage Plan that includes Plan D. Those that goes into the donut hole which begins after more than $2,800 has been accumulated in the Medicare Part Costs. These individuals will receive a $250 rebate from the U.S. Department of Health and Services agency Medicare and Medicaid Services.

The rebate checks will be issued by the government, not by the companies. Individuals who have hit the donut hole before June 1 will receive their check in June. Those reaching the donut hole after June 1 will receive their $250 in the next quarter. This rebate is being made to help with the prescription costs.

There are exclusions from the $250 Part D rebate. This includes those who receive a subsidy due to low income from both Medicare and Medicaid. Excluded are beneficiaries that exceed the Part B income thresholds. This means an individual income above $8,500 or annual adjusted income above $170,000. Also, those receiving Retiree Drug Subsidy are not eligible for the rebate.

Beginning in 2014 the beneficiaries in the donut hole will receive support for 50 percent of it. The implications are that it could mean higher premiums and co-pays for all enrolled in a Plan D.

Additional information about this $250 rebate may be obtained at www.medicare.gov. On the home page is a section, "What's New for Medicare."

In future columns, I will attempt to share with you some of the information that relates to the Patient Protection and Affordable Care and Act.

To be continued.