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Health Care Reform:

Health Insurance & Affordable Care Act

How Health Care Reform Affects Your Diabetes Care

As a person with diabetes, you stand to gain a lot from the Affordable Care Act (ACA), which reforms health care in the U.S. The law was passed in March 2010 and has been rolled out in phases. The final phase takes effect in January 2014.

Once the law is fully in place, health plans cannot deny coverage to people with diabetes. If you already have health insurance, you may see improvements in what your plan helps to pay for, and you may even see lower costs.

Learn how the new law can benefit you -- changes already in place, and what's to come.

Savings on Mail-Order Diabetes Supplies for Seniors

In July 2013, the National Mail-Order Program started. It now costs less to have diabetes supplies such as these delivered to your home:

  • Test strips
  • Lancets and lancet devices
  • Batteries
  • Control solution

You can only use this program if you have traditional Medicare. If you use a Medicare Advantage plan, ask your plan where to get supplies.

In the past, Medicare members paid an average of $15.58 a month for testing supplies. Now, you pay $4.50 a month.

You can buy supplies by mail order or from a store. But you must buy them from a Medicare-enrolled supplier to get this discount.

Ask your pharmacy if they accept "Medicare assignment." Or call 800-MEDICARE (800-633-4227) to find ones near you that do.   

Savings on Drug Costs for Seniors

The new law is helping to close the gap in Medicare coverage for prescription drugs. You probably know this gap as the doughnut hole.

The doughnut hole occurs after you and your health plan have spent a combined amount of $2,970. After you hit that amount, you’re in the doughnut hole. That means your health plan will not help pay for your medicines again until you have spent another $4,750.

Now it's easier to afford your Medicare prescription  drug benefits (Part D), and it will continue to get easier. This is great news for older adults with diabetes who use insulin or take diabetes medicine.  

Doughnut hole shrinks. While in the doughnut hole, in 2013 you pay 47.5% of the cost for a brand-name medicine. This will steadily decrease to 25% in 2020. After 2020, the doughnut hole will disappear.

For generic medicine, you pay 79% of the cost in 2013. This will steadily decrease to 25% in 2020. Again, after 2020, the doughnut hole will disappear.

Get out of the doughnut hole faster.  You pay only part of a medicine's cost, but its full price counts toward your out-of-pocket costs. That helps you more quickly reach the amount you need to spend to get out of the doughnut hole.

Here's an example. Say a brand-name drug costs $98 and has a $2 dispensing fee. In 2013, you pay 47.5% of $100, which is $47.50. However, the total amount of the medicine, $98, is added to your out-of-pocket costs, instead of just the $47.50 you paid. This benefit puts you much closer to the amount you need to get out of the doughnut hole -- $4,750.

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