As a person with diabetes, you stand to gain a lot from the Affordable Care Act (ACA), which reforms health care in the U.S. The law was passed in March 2010 and has been rolled out in phases. The final phase takes effect in January 2014.
Once the law is fully in place, health plans cannot deny coverage to people with diabetes. If you already have health insurance, you may see improvements in what your plan helps to pay for, and you may even see lower costs.
Learn how the new law can benefit you -- changes already in place, and what's to come.
Savings on Mail-Order Diabetes Supplies for Seniors
In July 2013, the National Mail-Order Program started. It now costs less to have diabetes supplies such as these delivered to your home:
Lancets and lancet devices
You can only use this program if you have traditional Medicare. If you use a Medicare Advantage plan, ask your plan where to get supplies.
In the past, Medicare members paid an average of $15.58 a month for testing supplies. Now, you pay $4.50 a month.
You can buy supplies by mail order or from a store. But you must buy them from a Medicare-enrolled supplier to get this discount.
Ask your pharmacy if they accept "Medicare assignment." Or call 800-MEDICARE (800-633-4227) to find ones near you that do.
Savings on Drug Costs for Seniors
The new law is helping to close the gap in Medicare coverage for prescription drugs. You probably know this gap as the doughnut hole.
The doughnut hole occurs after you and your health plan have spent a combined amount of $2,970. After you hit that amount, you’re in the doughnut hole. That means your health plan will not help pay for your medicines again until you have spent another $4,750.
Now it's easier to afford your Medicare prescription drug benefits (Part D), and it will continue to get easier. This is great news for older adults with diabetes who use insulin or take diabetes medicine.
Doughnut hole shrinks. While in the doughnut hole, in 2013 you pay 47.5% of the cost for a brand-name medicine. This will steadily decrease to 25% in 2020. After 2020, the doughnut hole will disappear.
For generic medicine, you pay 79% of the cost in 2013. This will steadily decrease to 25% in 2020. Again, after 2020, the doughnut hole will disappear.
Get out of the doughnut hole faster. You pay only part of a medicine's cost, but its full price counts toward your out-of-pocket costs. That helps you more quickly reach the amount you need to spend to get out of the doughnut hole.
Here's an example. Say a brand-name drug costs $98 and has a $2 dispensing fee. In 2013, you pay 47.5% of $100, which is $47.50. However, the total amount of the medicine, $98, is added to your out-of-pocket costs, instead of just the $47.50 you paid. This benefit puts you much closer to the amount you need to get out of the doughnut hole -- $4,750.
Free Preventive Care Available Now
If you have private insurance, you can get preventive care without paying a copayment or coinsurance. You can even get this care before you pay your deductible. Here's some preventive diabetes care:
Type 2 diabetes screening
Obesity screening and counseling
Blood pressure screening
Gestational diabetes screening for pregnant women
Are you enrolled in a plan that existed before March 2010? If so and the plan has not substantially changed, you're with a grandfathered health plan, and it may be exempt from this part of the law. Check the plan's summary of benefits to see if you can get free preventive care services.
No Lifetime Coverage Limits
Under the Affordable Care Act, health plans can no longer limit the amount they spend toward your care over your lifetime. They also can't cancel your policy to avoid paying for your care when you have diabetes.
Children With Diabetes Must Be Covered
The new law no longer allows health plans to turn away children under the age of 19, including those with chronic conditions such as diabetes. All plans must allow families with children who have diabetes to enroll. Young adults, including those with diabetes, can stay on their parents' plan until age 26.
Benefits Starting in 2014
The health care reform law will bring more benefits to people, including those with diabetes, starting next year.
Adults with diabetes cannot be kept from enrolling in a health plan because of their condition. The same is true for people with other chronic conditions.
Health plans won't be able to charge premiums based on your health. This means plans won’t be able to increase your monthly premium simply because you have diabetes.
Health plans will not be able to set a yearly limit on how much they pay for the cost of your care.
All health plans sold to individuals and small employers must provide essential health benefits. These plans will have benefits that are as comprehensive as plans that large employers offer to workers.
If you don't have insurance through your employer, you can buy insurance through your state's Marketplace, also called an Exchange. The Marketplace compares plans and premiums and answers your questions. And depending on how much money you make in a year, you may be able to get help to pay for a health plan when you enroll through your state's Marketplace.
You may qualify for Medicaid even if you haven't before, depending on how much money you make in a year and where you live.
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