Affordable Care Act: How Does it Rate for People with Disabilities?

Tuesday November 26, 2013

The Patient Protection and Affordable Care Act has been protecting people with disabilities for three years already. The law, sometimes called “Obamacare,” was enacted to increase options for funding health care. Lifetime limits for kids were banned. Young adults were allowed to stay on their parents’ policies until 26. Discrimination based on preexisting conditions is in effect. See more benefits below.

The Healthcare Marketplace under the Act now allows individuals and small businesses to shop for health plans. However, plans won’t go into effect until January 1, 2014 or later. There are subsidies to make plans affordable for most Americans.

You can find out about plans, rates and subsidies that are available and other information at the Affordable Care Act website, www.healthcare.gov .

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The Wisconsin Legislature is slated to meet the first week of December 2013 to consider legislation to delay changes to BadgerCare. The Legislature made changes to the Medical Assistance program that would force 77,500 residents off of the program.

Gov. Scott Walker called a special session of the Legislature to consider legislation to delay the change for low-income residents on the state’s Medicaid program. The Governor cited the rocky rollout of the Affordable Care Act and the uncertainty it caused in calling the session. However, Wisconsin had its own problems.

The Wisconsin Department of Health Services sent notices to people on BadgerCare insurance programs. The letters say that the recipient’s eligibility for the insurance may end at the end of December because of their income.

The letters are wrong in some cases, according to advocates. The Affordable Care Act provides a new way of calculating income for insurance programs as of January 1, 2014. Unfortunately, the state agency used income computed under the old method in issuing the letters.

Walker has also proposed extending the Health Insurance Risk-Sharing Plan, which would provide a safety net as residents transition from the state plan to the federal exchange.

Under Walker, Wisconsin has refused to expand Medicaid through ObamaCare. The biennial budget requires adults with incomes over the federal poverty line to transition from Medicaid to the federal exchanges. The budget does expand BadgerCare to include about 82,000 adults with dependent children who live below the poverty line and who hadn’t been included in the program before.

Walker’s proposal would delay moving those 82,000 adults onto BadgerCare in order to pay for the continued coverage of the 77,500 who will eventually move to the federal exchanges.

The special session comes after problems with the Healthcare.gov Web site, which have stymied efforts by many Wisconsinites to get new health care. Just 877 Wisconsin residents had picked a health-care plan through the federal marketplace as of Nov. 2, the Journal-Sentinel said .

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Seniors and people with disabilities with Medicare prescription drug plan coverage saved $8.9 billion to date on their prescription drugs thanks to the Affordable Care Act, according to new data released today by the Centers for Medicare & Medicaid Services (CMS). The data show $157 M of savings to Wisconsin families. At the same time, these seniors will be free to use more of their Social Security benefit cost of living adjustment on what they choose because the Medicare Part B premium will not increase in 2014, thanks to the health care law’s successful efforts to keep cost growth low.

Since the Affordable Care Act was enacted, more than 7.3 million seniors and people with disabilities who reached the donut hole in their Medicare Part D (Medicare Prescription Drug Coverage) plans have saved $8.9 billion on their prescription drugs, an average of $1,209 per person since the program began. During the first 10 months of 2013, nearly 3.4 million people nationwide who reached the coverage gap — known as the “donut hole” — this year have saved $2.9 billion, an average of $866 per beneficiary. These figures are higher than at this same point last year, when 2.8 million beneficiaries had saved $1.8 billion for an average of $677 per beneficiary.

“Protecting seniors from the dreaded donut hole and high prescription drug costs is an important Affordable Care Act reform that Medicare beneficiaries have come to depend on,” said CMS Administrator Marilyn Tavenner. “Today’s data shows that the law is already helping millions of seniors save billions of dollars off their needed medications.”

For many people enrolled in Medicare Part D, the Medicare “donut hole” is the gap in the Medicare prescription drug benefit before catastrophic coverage for prescriptions takes effect. Without Affordable Care Act assistance, Medicare beneficiaries would pay out-of-pocket for the entire cost of prescription drugs once they hit the donut hole, until they reach catastrophic coverage. But under the discount program in the Affordable Care Act, in 2010, anyone with a Medicare prescription drug plan who reached the prescription drug donut hole got a $250 rebate. In 2011, beneficiaries who landed in the donut hole began receiving discounts on covered brand-name drugs and savings on generic drugs. Next year, Medicare Part D participants who fall into the donut hole will receive savings of about 53 percent on the cost of brand name drugs and 28 percent on the cost of generic drugs. These savings and Medicare coverage will gradually increase until 2020, when the donut hole will be closed.

News on the continued savings on prescription drugs comes on the heels of new information showing historically low levels of growth in Medicare spending. For example:

CMS provides state-by-state information on savings in the donut hole on it’s website . You can find more information about Medicare’s prescription drug benefits at the Medicare site .

The Annual Open Enrollment period for health and drug plans began on October 15 and ends on December 7. For more information on Medicare Open Enrollment and to compare benefits and prices of 2014 Medicare health and drug plans, including state-by-state fact sheets, please visit CMS’ Open Enrollment page .

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Other Choices and Enhanced Protections for Americans with Disabilities under the Affordable Care Act.

Compiled from press and agency reports