ASK SAVA: What health-care changes become effective in 2011?

21 Feb ASK SAVA: What health-care changes become effective in 2011?

GRACE‐April, 2011

Q – I am concerned about the new health care changes and how I am affected. Can you give me an idea of Medicare participant drug changes as well as Medicare Advantage changes?

A – The Patient Protection and Affordable Care Act (PPACA), signed into law in 2010, makes significant changes to our health-care delivery system. Here are some of the most important changes scheduled to take effect in 2011.

The cost of over-the-counter drugs not prescribed by a doctor can no longer be reimbursed through a health reimbursement account or a health flexible spending account, nor can these costs be reimbursed on a tax-free basis through a health savings account (HSA) or Archer medical savings account. Also, the tax on distributions from HSAs and Archer MSAs that are not used for qualified medical expenses increases to 20% (up from 10% and 15% for HSAs and Archer MSAs respectively).

Medicare Part D participants will receive a 50% discount on brand-name prescriptions filled in the coverage gap (i.e., the “donut hole”) from pharmaceutical  manufacturers, and federal subsidies for generic prescriptions filled in the coverage gap will start to be phased in. Also, certain preventive services covered by Medicare are no longer subject to cost-sharing (copayments), the deductible is waived for Medicare-covered colorectal cancer screening tests, and Medicare now covers personalized prevention plans including a comprehensive health risk assessment.

Medicare Advantage (MA) plans can no longer impose higher cost-sharing for some Medicare covered benefits than would be imposed by traditional Medicare insurance. Also, MA plans cannot exceed a mandatory maximum out-of-pocket amount for most Medicare services. The maximum amount in 2011 is $6,700, but MA plans can voluntarily offer lower out-of-pocket amounts. Also, the annual enrollment period for MA plans is changed to October 15 through December 7.

The requirement that employers report the total value of employer-sponsored health benefits on employees’ W-2s was to begin in 2011. However, the IRS has deferred this requirement until 2012.