Protections Against Health Insurance Companies

No demographic group has suffered more from insurance abuses than older adults who are not yet eligible for Medicare.   Those protections include:

• Protections against common insurance industry practices that avoid covering treatment for the ill and injured
• Barring insurers from arbitrarily canceling coverage after illness or injury strikes, or that requires expensive treatment
• Barring lifetime caps on coverage amounts
• Requiring insurers to cover preventive care, such as mammograms, colonoscopies, and immunizations, with no out-of-pocket cost – no deductibles, co-payments, or co-insurance
• Denying or cancelling coverage due to a pre-existing medical condition

Protection Against Arbitrary Cutbacks in Eligibility, Quality, and Availability of Long-Term Care Services.

One important element to older adults takes effect immediately.  States are barred until 2014 from cutting back eligibility for long-term care services. This means that seniors receiving Medicaid coverage for critical services will have their eligibility guaranteed for at least the next three years.  

Provisions Effective in 2011 That Confer Critical Benefits on Older Americans

And, in 2011, a number of other positive provisions for low income older adults that NSCLC supports will take effect:

• Support for Care at Home. The law will make it easier for lower income people with Medicaid to get long-term care at home instead of in a nursing home by providing extra federal funds to states that provide in-home services.
• Improved Nursing Home Quality. Some nursing home quality standards will be improved and there will be enhanced training for workers who care for seniors.  Over half of all Americans will reside in nursing homes for some period during their lives, and two of every three nursing homes receive all or part of their financial support from Medicaid.
• Phasing Out the Donut Hole. If you do not qualify for the low-income subsidy under Medicare Part D, you may be subject to the donut hole. In 2011, you'll pay only half of what your plan charges for brand-name drugs—a 50% discount.
• Better Coordination for Dual Eligibles. The law provides for a new office in the federal government that will ensure that people who have both Medicare and Medicaid receive the best possible care.

In addition, there will be new protections against elder abuse, neglect, and financial exploitation as well as free wellness visits under Medicare and incentives to providers to coordinate care – all taking effect in 2011.

For more information, visit www.nsclc.org.