This Healthcare Update which represents highlights from CMS was written by Ronald Viggiani, MD and Emma Hitt, PhD, entitled “Helping You and Your Patient Take Advantage of New Healthcare Reform Provisions

Recent provisions in Medicare and insurance oversight aim to improve the quality of healthcare, lower the cost of care, provide access to affordable care, and protect consumers.

This advisory highlights several current provisions of the Affordable Care Act (ACA) and outlines what clinicians should know to help patients benefit now. Although many provisions are expected to roll out over the next several years, a number of important ones are already in effect.

Improving Quality of Care While Lowering Costs

The ACA provides assistance for patients with Medicare who have reached the coverage gap (ie, “donut hole”) in medication coverage (Medicare Part D). Patients paying for drugs in this gap will get a 50% discount on covered brand-name drugs and a 7% discount on generic drug purchases; additional savings are expected as this gap is closed over the ensuing years.[1] Despite these discounts, the entire drug cost counts toward the amount required to qualify for catastrophic coverage.

Patients with Medicare can now take advantage of a variety of preventive services without the need for copayments/coinsurance or deductibles. For more information on Medicare preventive services see this Medscape Healthcare Advisory.[2]

Patients enrolled in job-related health plans or in individual health insurance policies created after March 23, 2010 also may avoid copayments/coinsurance or deductibles when receiving recommended preventive health screenings, vaccinations, and counseling.[3] Additional details on this provision can be found at[3]

Improving Access to Affordable Care

If a parent’s or guardian’s health insurance policy covers children, they can now add or keep their children on the policy until they turn 26 years old.[4] (Before the ACA, health plans could remove enrolled children usually at age 19 or sometimes older for full-time students.)[4] Additional information on this provision can be found at[4]

To be continued in the next post