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When health care reform was first proposed, many believed that it would cut basic Medicare benefits. Instead, if you are on Medicare, your guaranteed Medicare benefits are protected and you will receive improved benefits. Starting January 1, 2011, changes to Medicare will lower the out-of-pocket cost for prescription drugs you need to stay healthy and expand the preventive care you can get for free, while making sure you can continue to see your doctor.
More than one in four Part D enrollees who filled prescriptions in 2007 reached the "donut hole," which is the range of prescription drug spending in which the consumer is responsible for 100 percent of his expenses. Most of these individuals did not reach the upper limit of the coverage gap before the year ended, meaning their coverage never kicked back in. A few did reach this limit and received what Medicare calls "catastrophic coverage," which pays for all of their prescriptions, according to a Kaiser Family Foundation study. Beginning in 2011, people in the coverage gap will be able to purchase brand-name drugs at half the current price and receive a seven percent discount on generic prescription drugs. The gap gradually will be eliminated by 2020. Reform also improves the program that reduces drug costs for seniors with limited means and makes it easier to appeal coverage denials.
Four out of five older Americans have at least one chronic medical condition, such as heart disease, high blood pressure or diabetes, and more than 90 percent of Medicare costs are for treating these conditions. Starting 2011, Medicare beneficiaries who request it will receive one free wellness visit each year, allowing you and your doctor to develop a prevention plan to keep you healthy. You also will receive free preventive screenings and a range of prevention services, such as cancer and diabetes screenings, mammograms, colorectal and prostate cancer screenings, bone mass measurement, nutritional and smoking cessation counseling and flu, hepatitis and pneumococcal shots.
Most older adults see several doctors, who may not always work together. The new law funds community health teams, medical homes and care coordination to improve the quality of care that seniors receive and provide patient-centered care to better control chronic medical conditions. If you must be hospitalized, the law also will help you return home successfully, and avoid going back into the hospital, by providing incentives for hospitals to make sure that you get the services you need in your community and by teaching you ways to take good care of yourself.
The law also will make it easier to receive and pay for long-term care at home. Medicare currently does not cover long-term care, which means millions of older adults who need help at home must spend their life savings to get the care they need. However, starting in 2011, it will be easier for lower income people who are on Medicaid to get long-term care at home instead of in a nursing home by providing extra federal funds to states that provide in-home services.