Many families already know how the new health care law, the Affordable Care Act, is helping them. They've been able to maintain coverage for their college-age children, or buy health insurance after being previously labeled "uninsurable." North Dakota seniors are saving millions of dollars through discounts on expensive prescription drugs. But if none of these realities are yours, you may be wondering, "What's in the new health care law for me?"
AARP's Health Law Guide (www.aarp.org/healthlawguide) can create a personalized report that tells you how the law will help you. If you are uninsured, your report will identify coverage you may be eligible to receive.
Because different parts of the law will go into effect over a number of years, it is a good idea to learn about the changes that are in store. In addition to providing your personalized report, the AARP Health Law Guide can help you stay on top of the law as it is implemented.
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Lyle Halvorson
In the meantime, here are just a few changes you may appreciate right now:
--If you are one of the 33 percent of people in North Dakota who will reach the Medicare Part D doughnut hole the threshold at which you are responsible for a higher portion of your drug costs you will receive a 50 percent discount on brand-name drugs and a 14 percent discount on generic drugs while you're in the coverage gap. In North Dakota in 2011, nearly 10,000 people in Medicare saved almost $6 million on prescription drug costs because of the Affordable Care Act. That averages out to almost $600 per person.
--For people with Medicare, the health care law does more than lower your out-of-pocket drug costs. You can now receive preventive care services such as mammograms, immunizations and screenings for cancer and diabetes, as well as an annual wellness visit, all at no cost to you. Prior to 2011, people with Medicare faced cost-sharing for many preventive benefits such as cancer screenings. Through the Affordable Care Act, preventive benefits are offered free of charge to beneficiaries, with no deductible or co-pay, so that cost is no longer a barrier for seniors who want to stay healthy and treat problems early.
--If private insurers consider you "high-risk" due to prior or current health problems, and if you have been uninsured for at least six months, you may buy insurance through the Pre-Existing Condition Insurance Plan (PHIP) in North Dakota.
--If you have an uninsured adult child under age 26, you may be able to add him to your family's existing insurance plan. In North Dakota, an estimated 5,000 additional young adults now have insurance coverage due to a provision in the Affordable Care Act that allows 19-25 year olds to remain on their parents' insurance plans.
--Children under age 19 can no longer be denied coverage for a pre-existing condition.
--Insurance companies cannot drop your coverage if you get sick, as long as you continue to pay the premiums.
--Insurance companies can no longer place lifetime limits on your coverage, and in 2014 insurance companies can't place annual limits on your coverage.
Whether you currently have health coverage or not, it's important to get the facts about how the law could impact your situation. In less than five minutes, AARP's Health Law Guide (www.aarp.org/healthlawguide) can help you figure out how the new law benefits you and your family, how the law works with your current coverage, and what other health coverage may be available.
Enrollment reminder
This year's Medicare Part D annual enrollment period begins Oct. 15 and ends Dec. 7. This is the time for people with Medicare, their families and their caregivers to choose their plans for next year by comparing their current coverage and quality ratings to other plan offerings.
The State Health Insurance Counseling Program will hold an enrollment session on Nov. 6 from 9 a.m. to 4 p.m. at the Grand International Inn in Minot. For more information, call toll-free 1-888-575-6611.
Average basic premiums for Medicare prescription drug plans are projected to remain constant in 2013 at $30 per month.
New benefit choices are effective Jan. 1, 2013.
Lyle Halvorson, of Bismarck, is associate director of AARP North Dakota.