WASHINGTON, D.C. - U.S. Sen. Sherrod Brown (D-OH) today announced new health reform benefits that took effect for Ohioans on January 1. As part of the Patient Protection and Affordable Care Act (PPACA)—the new health reform law—Medicare beneficiaries will receive free annual wellness check-ups, free preventive services and screenings, and 50 percent discounts on brand-name drugs and biologics in the Medicare prescription drug coverage gap, also known as the “donut hole.”  In addition, insurance companies will now be required to spend 80 to 85 percent of premiums on health care and quality improvements for patients rather than overhead costs.

“I have heard from so many Ohio seniors struggling with rising medical costs. Seniors shouldn’t have to worry about how they’re going to afford doctor visits and ever-rising prescription drug costs, on top of their mortgages or rent or utility bills. This law works to ensure that seniors don’t have to make the choice between a meal and medicine,” Brown said. “These new benefits will work to remove financial barriers to important preventive health care services and annual wellness check-ups and will also make prescription drugs more affordable for seniors who end up in the Medicare ‘donut hole.’”

“By requiring insurance companies to spend the majority of premium dollars on patient care – rather than executive salaries or overhead – we’ll start to contain health costs. Ohioans deserve to know that their premium dollars are being used to promote their health – not line the pockets of insurance industry executives,” Brown continued.

According to the Centers for Medicare and Medicaid Services (CMS), approximately 1.8 million Ohio seniors will be eligible in 2011 for free preventive services and free annual wellness check-ups as a result of the new health reform law. Below are some of the preventive services that will be free (no co-payments or deductibles) for Medicare beneficiaries beginning Jan 2011:

  • Screening for colorectal cancer in adults, until age 75 years;
  • Osteoporosis screening for women aged 65 and older; and
  • ·         Mammography screening for women every 1-2 years

 

Nearly 100,000 Ohio seniors entered the “donut hole”—a gap in prescription drug coverage in the Medicare Part D program—last year. In 2010, seniors who entered the “donut hole” received $250 rebate checks to assist with their prescription drug costs.  Beginning in Jan 2011, the new health care law will provide Medicare beneficiaries with 50 percent discounts on brand-name drugs and biologics when they enter the “donut hole.”  Discounts will increase every year until 2020, when the “donut hole” will be closed altogether.

Beginning January 2011, health insurance companies are now required by law to spend 80 to 85 percent of premiums on health care and quality improvements for patients rather than on administrative costs. Insurers who have not redirected premiums so that at least 80-85 percent goes to customer care will be required to provide a rebate to their customers starting in 2012. This year, the new rules will protect up to 74.8 million insured Americans and estimates indicate that up to 9 million Americans could be eligible for rebates starting in 2012 worth up to $1.4 billion. Average rebates per person could total $164 in the individual market.

Already, the Affordable Care Act has opened up access to quality health care and helped small companies provide health insurance to their employees. Provisions that took effect in 2010 include:

  • Prohibiting denial of coverage to children who were excluded due to preexisting conditions
  • Extending coverage to young adults up to age 26 so they can stay covered as they start their careers
  • Delivering tax relief for small businesses across Ohio to help them continue to provide health insurance to their workers
  • Creating a system to help early retirees not yet eligible for Medicare keep their savings and stay insured
  • Requiring all new plans to provide free preventative screenings including mammograms and colonoscopies
  • Ending insurance companies’ ability to rescind coverage when people get sick or impose lifetime caps on those with chronic illness
  • Investing millions into community health programs and helping states like Ohio provide coverage for low income families through Medicaid

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