Affordable Care Act Impact On The Medicare Donut Hole

Certified as an elder law attorney by the National Elder Law Foundation under authorization of the Pennsylvania Supreme Court

Certified as an elder law attorney by the National Elder Law Foundation under authorization of the Pennsylvania Supreme Court

(2010)When Congress passed the new health care law recently, much of the attention focused on expansion of coverage in the workforce and to the uninsured.

But the new law also contains provisions of interest to the elderly, and those who provide services to them. Here is a brief summary of some of those provisions.

Medicare “Donut Hole.”

Those who receive Medicare Part D prescription drug coverage are familiar with the coverage gap popularly known as the “donut hole,” which requires enrollees to pay out-of-pocket for annual drug costs between $2,830 and $6,440.

The new law provides a $250 rebate in 2010 for those affected by the donut hole. Beginning in 2011, a 50% discount will apply to prescription medicines in the gap. By 2020, the law calls for complete closure of the gap.

Long-term care insurance.

The new law provides for a voluntary long term care insurance program to provide benefits of at least $50 per day on average. The program is to be funded by the participants, without the use of taxpayer funds to pay for benefits.

Nursing home transparency and improvement.

Nursing facilities will be required to provide information to the government about staffing levels, wages and benefits, organizational structure and ownership. More information will be made publicly available through the existing Nursing Home Compare Medicare website, and the Government Accountability Office will study potential improvements to the website’s Five-Star Quality Rating System.

Facilities must also include dementia management and abuse prevention training as part of their initial training for new employees.

A nationwide program for national and state background checks will be established for employees of long-term care facilities who have direct patient access.

Home and community based services.

There are a number of provisions in the new law to encourage greater use of home and community based services for the elderly requiring long-term care, such as financial incentives for states and protection against spousal impoverishment.

Elder Justice Act.

This act provides federal resources aimed at fighting elder abuse. Long-term care facilities will be required to report suspected crimes committed at a facility.

Annual wellness visit.

Medicare enrollees can receive an annual wellness visit and personalized prevention plan services (including a comprehensive health risk assessment), with no co-payment or deductible.

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