Health care reform targets Medicare 'donut hole', includes disability benefits

The new health care reform law targets the “donut hole” in Medicare Part D prescription drug coverage and provides community living assistance for people with disabilities. We explore the measures here as part of our series on what reform means to you.

Q: What is the Medicare Part D “donut hole?”

A: The “donut hole” for Medicare Part D prescription coverage refers to the point in time when a member reaches $2,830 in out-of-pockets costs for medications. Currently, members pay 100 percent toward all medication after their costs exceed $2,830 until their costs reach $6,440, at which time 100 percent of costs are covered.

Q: Who qualifies for the $250 rebate for Medicare Part D? How do I receive my rebate?

A: An individual who reaches the “donut hole,” or Part D coverage gap, will receive a $250 credit payment. The federal government will remit this payment by no later than the 15^th day of the third month following the end of the calendar quarter in which the individual reaches the donut hole.

Q: What does the Patient Protection and Affordable Care Act do for people with disabilities?

A: Effective Jan. 1, 2011, the law creates a new national long-term care program for persons with disabilities that provides community living assistance services and supports.

The so-called CLASS Act will provide benefits of at least $50 per day to help persons with disabilities to maintain community living. It will be financed by a new, voluntary payroll deduction – expected to be about $65 per month – by all working adults (persons are automatically enrolled and may then opt-out of the program). These funds may be used for home health care, adult day care, nursing homes and assisted living homes, among other benefits.

However, persons must have contributed for at least five years to be eligible for the benefits.

More on what health care reform means to you:

·        What health care reform means for Michigan Blues members who buy individual policies

·        How health care reform impacts ‘Cadillac’ plans, small businesses and group plans

·        Health care reform: high-risk pool aims to spread insurance to patients with costly medical conditionsWhat national health care reform means for Michigan Blues members

Tomorrow: What to expect from health care reform if you buy a new policy today