• Skip to main content
  • Skip to secondary menu
  • Skip to primary sidebar
  • Skip to footer
California Health Advocates

California Health Advocates

  • Contact
  • Home
  • About Us
    • Contact
    • Our Team
    • Mission
    • Education Services
    • About HICAP
    • Press
    • Testimonials
  • MEDICARE COUNSELING
  • Fact Sheets
  • Topics
    • The Basics
    • Prescription Drugs
    • Low-Income Help
    • Medigap
    • Medicare Advantage
    • Other Health Insurance
    • Appeals
    • Billing & Claims
    • Disabilities
    • Long-Term Care
    • Tribal Nations & Medicare
    • Health Care Reform
    • Advocacy & Policy
    • Glossary
  • Fraud & Abuse
  • Medicare Complaints
  • Blog
  • Donate

What Does Health Care Reform Legislation Mean for Medicare Beneficiaries?

California Health Advocates > Health Care Reform > What Does Health Care Reform Legislation Mean for Medicare Beneficiaries?

Posted by Karen Joy Fletcher on April 1, 2010

Below is a brief summary of some of the main changes the recently passed health care reform will bring for Medicare beneficiaries.

  1. The Medicare Part D “donut hole” – or coverage gap where beneficiaries must cover 100% of their drug costs – will go away by 2020. Beneficiaries with Part D will gradually pay less until they are responsible for 25% of their drug costs (or costs above their deductible and below the catastrophic limit). This means as of 2020, 75% of brand-name and generic drug costs will be covered by Part D. Starting immediately, however, people who reach the donut hole will receive a $250 rebate. In 2011, people who reach the gap will receive a 50% discount on brand-name drugs.
  2. The legislation also eliminates out-of pocket costs for a wide range of Medicare-covered preventive care services. Starting in 2011, it eliminates coinsurance payments and cost-sharing for preventive services, such as for prostate cancer screenings, mammograms, diabetes screening tests, and glaucoma screening tests.
  3. Federal subsidies to private Medicare Advantage plans, which currently cover about 25% of Medicare participants and cost the government more, on average, than traditional Medicare, will be begin to be cut in 2012. Over the next several years, the federal formula for reimbursing insurers will be reduced to bring them in line with traditional Medicare. As a result, some participating insurers may raise costs or cut extra non-Medicare covered services. (Note that all services covered by Original Medicare are required to be covered in every MA plan.)
  4. The new legislation also prohibits Medicare Advantage plans from charging seniors more for certain benefits, such as some chemotherapy, renal dialysis and skilled nursing services, than what beneficiaries would pay under the traditional fee-for-service Medicare program.

More information on additional changes will be provided in upcoming posts.

See UC Berkeley’s Center on Health, Economic and Family Security’s recent issue brief, “Advancing National Health Reform,” for more details on how the passed health reform affects California’s Medicare beneficiaries.

Filed Under: Health Care Reform, Medicare Basics

Previous Post: « Health Reform is Now Law – Immediate Changes Take Effect
Next Post: Medicare Issues Sanction Notice to Aetna Insurance Company »

About Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA's Communications Director. With a Masters in Public Health from UC Berkeley, she is the online "public face" of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a "communicator" and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.

Related Posts

  • Tell Congress to Say Yes to Medicare Improvements ~ Now is the Time!
  • Final California Budget Makes Historic Investments for Older Adults
  • House Passes Historic Bill to Lower Drug Prices & Expand Medicare
  • President’s Executive Order Tips the Scales Even More in Favor of Private Medicare Advantage Plans Over Original Medicare

Primary Sidebar

Change Text Size

  • 100%  110%  120%  130%  

News & Blog Categories

  • Medicare Advantage
  • Low-Income help
  • Medicare & Disabilities
  • Medicare Basics
  • Prescription Drugs
  • Medicare & Other Health Insurance
  • Medicare Billings, Claims & Appeals
  • Health Care Disparities
  • Fraud & Abuse

—

  • COVID-19
  • Resources
  • Health Care Reform
  • Long-Term Care
  • CHA News

—

  • Advocacy & Policy
  • Letters and Comments to Policymakers
  • Legislative and Congressional Testimony
  • Policy Briefs

Send Us Comment

Do you have comments or concerns about your Medicare coverage? Issues regarding getting your needed prescriptions from your Part D plan, or a Medicare Advantage plan representative's marketing practices? Let us know at comments@cahealthadvocates.org.

We are dedicated to making Medicare's program work well for all beneficiaries. Your feedback from your own or your client's concerns and experiences with Medicare, will guide our Medicare advocacy efforts with key policy and decision-makers in both California and nationally with the Centers for Medicare and Medicaid Services (CMS) and Congress.

Archives

Donate Today

Footer

Sign up for our newsletter

Choose the news you'd like to receive

Important Links

  • About Us
  • Fact Sheets
  • Blog
  • Donate
  • Contact
  • Privacy Notice
  • Cookie Policy
  • Accessibility Statement

Follow Us

Copyright © 2023 · California Health Advocates · Web Design by TWK Web and Print Design · Log in