For people in Medicare, this year brings important new benefits under the Affordable Care Act, the new health care law.
First, out-of-pocket prescription drug costs will be lower if you reach the Medicare Part D coverage gap or "doughnut hole" in 2011. Once you hit the doughnut hole, you will receive a 50 percent discount on brand-name prescription drugs and a 7 percent discount on generic prescription drugs while you are in the coverage gap. (The discounts will gradually increase every year until this coverage gap completely disappears in 2020.) As long as you are enrolled in a Medicare Part D prescription drug plan, you don't need to do anything to get these benefits.
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 less expensive drugs in your plan.
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Lyle Halvorson
Equally important, the new law expanded coverage for wellness and preventive care which took effect Jan. 1. People in Medicare now qualify for a new annual wellness visit, mammograms, colonoscopies and other screenings for cancer and diabetes with no out-of-pocket cost.
Physical exam
Medicare will continue to cover a "Welcome to Medicare" physical exam for people who are new to the Medicare program. This free exam, which has no deductibles or co-payments, is available during the first 12 months of enrollment into the Medicare program.
The new law also brings improvements to long-term care services. You will have access to more information about nursing home inspections, complaints against facilities and consumer rights. The new health care law provides nursing home residents with more protections from abuse, and it makes more information available about nursing homes so consumers can be better informed when selecting a nursing home, or monitoring the care of a loved one who resides in a nursing home.
States may also receive more funds to expand home- and community-based services. For example, under the Community First Choice Option, participating states get more federal dollars to provide home- and community-based services to people with disabilities who live at home but need a higher level of care.
In addition, here are some of the ways the new law is helping your children and grandchildren.
Children up to age 19 can no longer be denied coverage due to pre-existing health conditions. Free immunizations and other services are now available for infants and children. Young adults can remain on or return to their family health coverage until their 26th birthday.
Adults whom private insurers consider to be "high-risk" due to prior or current health problems and who have been uninsured for at least six months are eligible to buy insurance through the federal Pre-Existing Condition Insurance Plan (PCIP) in their state. To learn more and to apply, go to (www.pcip.gov).
Find out more
To learn more about the Affordable Care Act, go to (www.aarp.org/getthefacts). You'll find numerous fact sheets specific to certain groups of people. You can also e-mail your questions about the new law to NewHealthCareLaw@aarp.org.
Lyle Halvorson, of Bismarck, is associate director of AARP North Dakota.