Skip to content

    Health Care Reform:

    Health Insurance & Affordable Care Act

    How Health Care Reform Affects Your Diabetes Care

    Savings on Drug Costs for Seniors continued...

    For generic medicine, you pay 58% of the cost in 2016 and 51% in 2017. This will steadily decrease to 25% in 2020. Again, after 2020, the donut hole will disappear.

    Get out of the donut 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 donut hole.

    Here's an example. Say a brand-name drug costs $98 and has a $2 dispensing fee. In 2016, you pay 45% of $100, which is $45. However, the total amount of the medicine, $98, is added to your out-of-pocket costs, instead of just the $45 you paid. This benefit puts you much closer to the amount you need to get out of the donut hole -- $4,850 (in 2016).

    Free Preventive Care Available Now

    If you have private insurance, you can get preventive care without paying a copayment or coinsurance. You can even get this care before you pay your deductible. Here's some preventive diabetes care:

    If you are enrolled in a plan that existed before March 2010 and hasn't changed substantially, you are grandfathered and exempt from this part of the law. Check the plan's summary of benefits to see if you can get free preventive care services.

    No Lifetime Coverage Limits

    Under the Affordable Care Act, health plans can no longer limit the amount they spend toward your care over your lifetime. They also can't cancel your policy to avoid paying for your care when you have diabetes.

    Children With Diabetes Must Be Covered

    The new law no longer allows health plans to turn away children under age 19, including those with chronic conditions such as diabetes. All plans must allow families with children who have diabetes to enroll. Young adults, including those with diabetes, can stay on their parents' plan until age 26.

    Today on WebMD

    stethoscope on person's chest
    Your Marketplace choices,
    How not to waste money on health care.
    man in cafe looking at computer
    Finding low-cost health insurance.
    doctor showing girl a stethoscope
    Get the facts on health insurance.

    Latest Health Reform News

    Loading …
    URAC: Accredited Health Web Site TRUSTe online privacy certification HONcode Seal AdChoices