Health Reform and Seniors: an Overview

The new Health Reform legislation included many positive changes for older adults, and for their families and caregivers. Some seniors will notice benefits immediately—a $250 rebate will be mailed this year to help those caught in the Medicare Part D "donut hole." Other benefits, such as care coordination and wellness programs, represent a system-wide shift, putting money into early interventions in an effort to reduce the cost of chronic care treatment and improve health. 

More Options for Long-Term Care 

States will have more flexibility to participate in Medicaid programs that will help more low-income individuals remain in their homes instead of institutional care. Washington State has long been a leader in providing community-based options to nursing homes.

To encourage people to plan for their future long-term care needs, the bill creates a new voluntary long-term care insurance program, Community Living Assistance Services and Supports (CLASS) that would permit working adults to contribute to a fund that will provide a cash benefit if they become chronically ill or disabled. This benefit can be used to pay family caregivers for personal assistance.

Aging and Disability Resource Center (ADRC) initiatives will continue to receive funding through 2014. ADRCs expand upon the Senior Information & Assistance program model with a focus on helping people plan for their long-term care needs.

Emphasis on Prevention, Wellness and Care Coordination

The bill provides more support for community-based prevention and wellness programs, including a "Healthy Aging, Living Well" program that will provide more preventive health services, help reduce chronic diseases, and address health disparities.

Annual wellness visits will be fully covered (no co-payment or deductible) for Medicare participants, and will include the creation of a personalized prevention assessment and plan. Beginning in 2011, all preventive services, such as cancer screenings, will be free. Health plans for all ages will be required to cover prevention services and immunizations.

Funding for new coordinated care projects in Medicare will encourage doctors to improve care coordination for patients (and their families) with multiple chronic health conditions.  The funding will also be used to develop and test chronic care models.

Improvements to Medicare Coverage

In addition to the $250 "donut hole" payment mentioned earlier, Part D beneficiaries will receive a 50% drug discount beginning in 2011. By 2020, the donut hole will be closed altogether.

The annual enrollment process for Medicare beneficiaries will be streamlined—enrollment periods for Parts C and D will begin October 15 and end December 7, avoiding the busy holiday season—and seniors enrolled in Medicare Advantage plans will have an annual 45-day disenrollment period during which they can transfer to the original Medicare fee-for-services program under Part A and B. Subsidies for Medicare Advantage plans will be reduced, bringing these programs in line with costs for traditional Medicare plans, and lowering premiums over all.

To help older adults understand all their options, there will be additional funding to support outreach and assistance for Medicare Part D and low-income prescription drug programs. 

Changes to Medicare reimbursement rates should increase rates in Washington State, enabling more providers to continue accepting Medicare patients.

Expand Insurance Coverage for All Ages

In an effort to help family caregivers and "pre-retirees" retain their health coverage, a temporary "reinsurance program" will be created. As many caregivers drop out of the workforce early in order to care for a family member, this program will allow family caregivers in the 55 to 64 age group to keep their insurance coverage until they become eligible for Medicare at 65.   

Effective July 1, 2010, insurance companies cannot deny coverage to children with pre-existing conditions. This will be expanded to all ages in 2014 and will also prevent companies from discriminating based on health status and gender. Dependents up to age 26 may remain covered on their parents' insurance plans.

Strengthen the Geriatric Care Workforce

To prepare for the anticipated aging boom and to better respond to the health care needs of older adults, the bill includes funding to support training in geriatrics, chronic care management, and long-term care for health professionals, direct care workers and family caregivers. 

The bill also establishes federal traineeships for individuals pursuing degrees in geriatric nursing, long-term care, and geropsychiatric nursing, and provides grants to foster greater interest among health professionals to enter the field of geriatrics, long-term care, and chronic care management.

Elder Abuse Prevention and Enforcement

The Elder Justice Act was included as part of the Health Reform legislation. This act establishes a comprehensive national strategy to address elder abuse, neglect and exploitation. Some specific actions include:

• Enhance the training, recruitment and staffing in long-term care;
• Enhance state adult protective service systems, long-term care ombudsman programs, and law enforcement practices; and
• Implement new nursing home transparency and criminal background check requirements.

For More Information

The Kaiser Family Foundation has some excellent resources available, including an implementation timeline, a detailed summary of the final bill, an interactive comparison tool, and detailed descriptions of Medicare and Medicaid provisions.

If you have questions about your health care coverage, contact the local Senior Health Insurance Benefits Advisors (SHIBA) helpline at 1-800-562-6900, or complete their on-line help form.