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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 72% of the cost in 2014 and 25% in 2015.. 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.

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:

  • Type 2 diabetes screening
  • Obesity screening and counseling
  • Nutrition counseling
  • Blood pressure screening
  • Gestational diabetes screening for pregnant women

Are you enrolled in a plan that existed before March 2010? If so and the plan has not substantially changed, you're may be 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 the age of 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.

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