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:
- Type 2 diabetes screening
- Obesity screening and counseling
- Nutrition counseling
- Blood pressure screening
- Gestational diabetes screening for pregnant women
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.