National Health Care Reform: A Brief Summary for Seniors and Medicare Recipients

Congress has passed monumental legislation this past year which will change the way our health care system operates in our state and nationwide. I attended an information session on health care reform ran by Representative Hogan, Jessica Constantino of AARP and Deb Thompson of the PASS Group (Public Advocacy and Support Strategies) a couple of weeks ago. The material that was handed out and the presentation given were very informative, and I thought what I learned could be useful to constituents, especially for senior citizens and those on Medicare.

Doughnut Hole

Over the next decade, several steps will be taken to improve health care coverage and service. One of the first things to change is prescription coverage for those with Medicare Part D coverage. Those who reach the “doughnut hole” in prescription costs will automatically receive a $250 rebate. The first checks were mailed out starting on June 10, 2010. One big advantage to this aspect is that Medicare will keep track of your prescription spending. While it is always a good idea to keep your own records of spending, you do not need to submit any application in order to receive the $250 rebate.  Next year, these same people who have Medicare Part D coverage a reach the doughnut hole will receive a 50% discount on brand-name and biologic drugs bought inside the gap. Discounts will continue to increase for generic and brand name drugs until the gap closes in 2020.

AARP’s Doughnut Hole Calculator:

Fall 2010-2011

A big wave of change will also take place this fall. Effective September of 2010, health insurance companies will no longer be able to drop coverage if you become ill, place age limits on benefits, or use arbitrary annual limits on benefits. Positive improvements also involve eligibility for a temporary high-risk program if you have a preexisting condition and have been uninsured for at least six months, as well as no additional charges on preventative care services (mammogram, bone density scan, diabetes screening etc.) under new private plans. Those covered by Medicare will also gain access to free wellness and preventative care starting in 2011. There will also be some reform in nursing homes starting in 2011; it will be easier to file complaints and access information on standards and resident rights.


The next big wave of change will occur in 2014, making further improvements in the span of people covered. If you do not have health insurance, you can purchase insurance through exchanges (“purchasing pools”), which must begin offering insurance no later than 2014. You will receive a penalty is you are eligible for insurance through an exchange but do not buy it. To increase affordability, subsidies will be available to those with low income on a sliding scale (AARP reports that this applies to individuals with income $14,403 to $43,320). In 2014, health plans cannot deny coverage due to current health, past medical problems or gender. They can also no longer chare more than three times the amount they charge younger adults than they do seniors (some seniors are currently being charged upwards of ten times as much). But, companies can begin to increase premiums by a staggering 50% if you are a smoker. 2014 also brings more reform to limits in health care that currently impede service and treatment; companies are prohibited to place annual limits on coverage or deny anyone on the basis of a preexisting condition.

Though all of the changes included in this bill will not be enacted until 2020, improvements have already begun. While the United States is still well behind other countries in quality and extent of health care coverage, our system is on its way to providing affordable, comprehensive, and accountable care for all.

*facts and information provided by materials from AARP and the aforementioned speakers at the health care reform information session

AARP’s User’s Guide to Health Care:– Consumer Alert: National Health Care Reform: What Does it Mean for Massachusetts?

US Department of Health and Human Service’s Website on Health Care:

A More Detailed Timeline from the American Medical Association: