Ringing in the New Year with New Health Care Benefits

By Kathleen Sebelius, Secretary of Health and Human Services
Posted January 04, 2011

Some of the most important provisions of the Affordable Care Act will take effect in 2011.  Starting this year, the vast majority of people with Medicare will see several new benefits, including free annual wellness check-ups, recommended preventive services without cost-sharing and discounts on prescription drugs in the Medicare Part D “donut hole.”  In addition, new rules will hold insurance companies accountable so more of your premium dollars go to health care, and you’re more protected from unreasonable rate hikes.

Here are some of the new benefits to look out for:

  • Medicare will no longer have out-of-pocket costs for the “Welcome to Medicare” physical exam starting on January 1, 2011 and, for the first time since the Medicare program was created in 1965, Medicare will cover an annual wellness visit with a participating doctor, also at no cost.  This will allow beneficiaries enrolled in Medicare for more than 12 months to meet with their doctors once a year to develop and update a personalized prevention plan as their needs change over time. 
  • Most people with Medicare will be able to receive free preventive services, including flu shots, cancer screenings and diabetes testing.
  • Seniors who reach the coverage gap will receive a 50 percent discount when buying brand-name prescription drugs covered by Medicare Part D.  Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020.
  • Many doctors and other health care professionals who provide primary care to people with Medicare will get a 10 percent bonus.  This will help ensure that primary care providers can continue to be there for Medicare patients.
  • Insurance companies will be required to spend most of your premium dollars on health care and quality improvement, instead of administrative costs, big salaries, or marketing, or provide you with a rebate.  Specifically, the new law generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement.  For plans sold to individuals and small employers, at least 80% of the premium must be spent on services and quality improvement.  If insurance companies do not meet these goals because their administrative costs or profits are too high, they must provide rebates to consumers.
  • New proposed rules would require many insurers in all states to publicly justify unreasonable rate increases.  Under this proposed rules, rate increases of 10 percent or higher would be thoroughly reviewed to determine if the rate increase is unreasonable.  Insurance companies’ justifications for unreasonable increases would be posted on HealthCare.gov and the insurance plan’s website.