The new health care law will provide immediate benefits to people 50 and older, including those on Medicare.
For people who are on Medi-care or retired, one of the most important things to know is that the Patient Protection and Affordable Care Act does not eliminate or reduce benefits under Medicare. In fact, the new law expands coverage for wellness and preventive care. You'll qualify for a new annual wellness visit, mammograms, and other screenings for cancer and diabetes at no charge.
These new benefits start in January.
The law will also lower your out-of-pocket prescription drug costs. This year, if you are among the one-third of those in North Dakota who reach the Medicare Part D coverage gap or "doughnut hole," you will receive a $250 rebate to help pay for prescription drugs. Next year, if you reach the doughnut hole, you will receive a 50 percent discount on your brand-name prescription drugs and a 7 percent discount on your generic prescription drugs while you are in the coverage gap. The "doughnut hole" will gradually narrow until it disappears in 2020. As long as you are enrolled in a Part D plan, you don't need to do anything to get these benefits. But, you should keep careful track of your medication bills.
If you have Medicare Part D, you may want to use AARP's Doughnut Hole Calculator at (www.aarp.org/doughnuthole) to estimate how much you'll spend on drugs for the year. The calculator can also show you how to delay or avoid falling into the doughnut hole by researching less expensive drugs in your plan.
As the baby boomers age, the ranks of people age 50 to 64 without health insurance are soaring. North Dakota has 13,000 people age 50-64 who are uninsured and another 24,000 people in that age group who buy insurance coverage on their own. People in this age group are more likely to have a pre-existing condition and are routinely denied individual insurance in the private market. Those who can get coverage end up paying three times more in premiums and twice as much in out-of-pocket costs than a person with job-based coverage.
The law creates new rules for insurance companies so that they can no longer discriminate against people who are sick or charge unaffordable rates based on age. In North Dakota, insurance companies can charge older people up to five times more for health care in the individual market. The new law will allow insurers to charge no more than three times what younger people pay for the same health insurance.
As many as 47,200 people age 50-64 in North Dakota may be eligible for a tax credit that helps make premiums affordable. An estimated 8,800 lower income North Dakotans in the same age group would qualify for even more protection from unaffordable health care costs through the Medicaid program.
Your children, grandchildren
Beginning this fall, if your insurance offers a family plan, adult children can be covered until they turn 26. No child under age 19 can be denied coverage because of preexisting medical conditions.
Long-term care needs
You can participate in a voluntary national insurance program to help you pay for some of your future long-term care services and supports. This new program will pay you a lifetime cash benefit if you paid into the system for five years while you were working. Starting in 2011, all working adults will be enrolled automatically in this insurance through a payroll deduction, unless they or their employer choose not to participate.
Beginning in 2014, the new law extends financial protections to more spouses of people on Medicaid. If you are married to someone on Medicaid who is receiving care services at home, you will have the same protections for your income and other resources as do spouses of those on Medicaid who live in a nursing home.
The new law also promotes independent living. States may receive financial incentives to provide greater access to the services and supports you need to live independently in your own home and community. Currently, North Dakota spends about 5 percent of its Medicaid long-term care dollars for the elderly and adults with disabilities on home and community care. In contrast, New Mexico, Washington and Alaska spent more than 50 percent on home and community care.
Go to (www.aarp.org/getthefacts) for answers to your questions about the new health law.
The AARP state office is willing to speak to groups about what health care reform means to you. Call 701-355-3653 (toll-free 866-554-5383) to arrange for a speaker or watch our Web page at (www.aarp.org/nd) for the most recent information.
Lyle Halvorson, of Bismarck, is associate director of AARP North Dakota.