Beginning on January 1, several new provisions of the Affordable Care Act go into effect. Insurers have been working feverishly on IT system updates, benefit form changes and other administrative changes.
These changes include new medical loss ratio rules, developed by the NAIC, requiring insurers to track how premium dollars. Several changes go into effect related to benefit upgrades; particularly for Medicare recipients.
“These benefits (described below) are important new building blocks of the new health law that will ultimately help ensure that more Americans have greater access to affordable, high-quality care,” said DeAnn Friedholm, director of Consumers Union’s health reform campaign.
Starting January 1, the Affordable Care Act will require:
- More Premium Dollars Going to Medical Care: If you are covered by an individual or small group policy, your insurer must spend 80 percent of the premiums it collects on medical care or activities that improve the quality of care. For those covered by large group policies, insurers must spend an even higher amount -- 85 percent. Beginning in 2012, insurers who fail to meet this “medical loss ratio” must provide policyholders with a rebate instead of pocketing those excessive premiums.
- New Medicare Preventive Health Benefits:If you are covered by Medicare, you can get an annual wellness visit and a personalized prevention plan at no cost. Medicare beneficiaries will also be able to get immunizations and screenings for cancer and diabetes without co-pays.
- Drug Discounts for Medicare Recipients: If you have Medicare prescription drug coverage (Part D), you will be eligible for a 50 percent discount on brand-name drugs and a 7 percent discount on generic drugs if you have a coverage gap (also know as the “donut hole”). These discounts will increase each year until the donut hole is completely eliminated by 2020.
- Increased Funding for Community Health Centers: If you rely on Community Health Centers for free or low cost care, you’ll benefit from new federal funding to support these centers.
- Hospitals Must Report Certain Patient Infections: Hospitals will now have to track and report to the Centers for Disease Control and Prevention's National Healthcare Safety Network when patients get central line associated bloodstream infections (CLABSIs) in intensive care units. HHS plans to issue a public report on hospital-specific CLABSI infection rates later in the year. By requiring public reporting of infection rates, HHS aims to help patients learn more about their hospital’s infection control track record and put pressure on hospitals to improve their care.
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