Medicare Market

How will Medicare benefits be affected?
The law will not cut guaranteed Medicare Part A and B benefits. Beginning in 2011, beneficiaries will have some additional benefits they do not have today, including certain Medicare-covered preventive services at no cost. However, under the law, government payments to Medicare Advantage plans will be reduced over the next decade. Currently, Medicare Advantage plans often offer extra benefits that beneficiaries in traditional Medicare do not get. It is possible that some of these extras may change, and premiums and benefits may change due to the reductions in government payments.
What is the Medicare prescription drug "donut hole" and how will the new law affect it?
In 2010, about 4 million beneficiaries will hit the "donut hole," also known as the coverage gap in Medicare prescription drug coverage. As part of the new law, when certain beneficiaries hit the prescription drug coverage gap in 2010, they will be provided with a $250 government-issued check. Checks began going out to beneficiaries in June 2010.

Beginning in 2011, beneficiaries who reach the donut hole will have a lower co-insurance rate of 93 percent for generic drugs and will receive a 50 percent discount on brand-name drugs and biologics. These brand-name discounts and out-of-pocket costs will count toward the beneficiary's catastrophic threshold calculation. Over time, the health care reform law will narrow, eventually eliminating the donut hole. The law will also continue to phase-down cost sharing for both brand-name and generic drugs.
When will Medicare beneficiaries begin receiving preventive care at no cost?
Beginning in January 2011, Medicare-covered preventive services in traditional Medicare will be offered with no cost sharing. Detailed information will be available on the official Medicare website at www.medicare.gov.
Will Medicare cover adult dependents in the same way that private health insurance will?
No. The provision related to coverage of dependents up to age 26 does not apply to Medicare.
Do the essential benefit coverage requirements for small and large group insurance markets apply to Medicare and Medicare Advantage?
Medicare Advantage plans have to offer all Medicare Parts A and B benefits, and most Medicare Advantage plans also include Medicare prescription drug benefits, also known as Medicare Part D. These are not the same as the "essential benefits" required for the individual and small group insurance markets.
Does the new health care reform law make any changes to long-term care?
The new law creates a new voluntary insurance program called the Community Living Assistance Services and Supports (CLASS) Program to help pay for long-term care and support at home.

This information is provided for informational purposes only and does not constitute legal advice. Please consult your legal counsel regarding your specific situation.

Please note that this content is only intended to describe national health care reform requirements under the Patient Protection and Affordable Care Act (PPACA). It does not address Massachusetts law requirements or the potential impact of Massachusetts law on federal PPACA requirements.

For purposes of PPACA implementation, Blue Cross Blue Shield of Massachusetts assumes the plan year is the policy year, unless an account notifies us otherwise.