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The Affordable Care Act (Obamacare): If You Do Not Have Health insurance (Uninsu


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The Act Improves Medicare Part D coverage (the drug benefit) by the following:

Rebate: A $250 rebate will automatically be sent to Medicare beneficiaries who reach the so-called doughnut hole in 2010 (effective January 1, 2010)

Doughnut hole: The beneficiary coinsurance rate in the doughnut hole for brand name drugs is gradually reduced over time from 100% to 25% by 2020. For a schedule of the reductions, click here offsite link.

Brand-name drugs: The Act requires pharmaceutical manufacturers to provide a 50% discount on prescriptions filled in the Medicare Part D coverage gap beginning in 2011, in addition to federal subsidies of 25% of the brand-name drug cost by 2020 (phased in beginning in 2013.)

Generic drugs, the Act provides federal subsidies of 75% of the generic drug cost by 2020 for prescriptions filled in the Medicare Part D doughnut hole (phased in beginning in 2011.)

Preventive Services: Medicare recipients will not be charged co-pays or deductibles for basic preventive care such as immunizations, effective January 2011.

Dual eligible beneficiaries (people who qualify for both Medicare and Medicaid):

  • The Act makes Medicare Part D cost-sharing for full-benefit dual eligible beneficiaries receiving home and community-based care services equal to the cost-sharing for those who receive institutional care (Effective no earlier than January 1, 2012).
  • The Act aims to improve care coordination for people who are eligible for both Medicare and Medicaid by creating a new office in Centers for Medicare and Medicaid Services known as the Federal Coordinated Health Care Office..

Catastrophic coverage: Between 2014 and 2019, the Act reduces the out-of-pocket amount that qualifies an enrollee for catastrophic coverage in Medicare Part D .

Income-related Medicare Part B premiums: The Act freezes the threshold for such premiums for 2011 through 2019 at 2009 levels.

Medicare Part D premium: The Act reduces the subsidy for people with incomes above $85,000/individual and $170,000/couple.

Personalization: The Act provides Medicare beneficiaries access to a comprehensive health risk assessment and creation of a personalized prevention plan. (The health risk assessment model is to be developed within 18 months following enactment).

Environmental Health Hazards: The Act expands Medicare coverage to individuals who have been exposed to environmental health hazards from living in an area subject to an emergency declaration made as of June 17, 2009 and have developed certain health conditions as a result (Effective upon enactment)

Medicare Advantage (MA) plans:

  • Payments to the insurers will be restructured by setting payments to different percentages of Medicare fee-for-service rates.  Some analysts believe that this will likely result in higher premiums or decreased coverage.
  • For individuals making more than $85,000 or couples making more than $170,000, subsidies would be reduced starting January 1, 2011.


  • The Act reduces Medicare payments to hospitals with excess preventable hospital readmissions (effective October 2012) and for hospital-acquired conditions (effective fiscal year 2015).
  • The Act establishes a hospital value-based purchasing program effective October 2012.

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