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Senior Citizen Politics
Awaiting Court Ruling: Consumer Guide to Health Care Reform Law
Senior citizens could lose several popular benefits created by Affordable Care
Act (Obamacare) that are already in place
By Mary Agnes Carey, KHN Staff Writer
June 22, 2012 -The Supreme Court is expected to rule within a week on some key constitutional challenges brought by
states against the 2010 health care overhaul law. The decision will have sweeping ramifications for consumers, state officials, employers and
health care providers, including hospitals and doctors.
While some of the key features don't kick in until 2014, the still-controversial law has already altered the health care
industry and established a number of consumer benefits.
Here's an FAQ about some of the law's provisions that are already up and running as well as major features of what's to
come, if the law stays in place.
Filling the Part D Doughnut Hole: Savings Could Disappear in Court Ruling
A Supreme Court ruling against the healthcare law could mean ‘a nasty hit in the wallet the next time millions of seniors
go to the pharmacy’
By Ron Pollack, Executive Director, Families USA
June 14, 2012
Medicare Drug Discounts for Seniors At Risk if Court Strikes Health Law
Over 5.1 million of those in Medicare drug plan saved more than $3.2 billion on drugs from March 2010 /
December 2011 - June 13, 2012
3 Large Insurers to Keep Features of
Obamacare Even if Court Strikes It Down
Unitedhealthcare to allow children to stay on parents’ policies to age 26, will not reinstate lifetime limits on coverage,
will continue to offer cancer screenings and other preventive services without a copayment - June 12, 2012
Obamacare Has Saved People in Medicare $3.5 Billion on Prescription Drugs
In four months of 2012, over 856,000 seniors have taken advantage of the Annual Wellness Visit provided in the Affordable
May 24, 2012
Sec. Sebelius Highlights Success in First Two Years of
Affordable Care Act has been particularly beneficial for senior citizens - March 23, 2012
New Ryan Budget Would Drastically Transform Medicare, Medicaid
GOP again pushes for senior citizens to buy private insurance but makes modification to previous proposal to allow room for
traditional Medicare - See video
By Marilyn Werber Serafini, KHN Staff Writer
March 21, 2012
Politics for Senior Citizens
I understand that the Supreme Court is reviewing the health law. Will the ruling change my current insurance?
The Supreme Court’s decision should have minimal impact on your current health insurance. But if the court strikes the
law down, insurers might decide to change some provisions of your coverage that were mandated by the law, such as allowing an adult child to
stay on your policy under age 26 and requiring insurers to provide some preventive services at no out-of-pocket-cost to you.
The lawsuit against the health law strikes at its key elements, including the "individual mandate," a requirement that
most Americans have health insurance by 2014 or pay a fine, and an expansion of the Medicaid program. The full impact won’t be known until the
I don't have health insurance. Under the law, will I have to buy it and what happens if I don't?
Right now, you are not required to have health insurance. But beginning in 2014, most people will have to have it or pay
a fine. For individuals, the penalty would start at $95 a year, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5
percent of income, by 2016.
For families the penalty would be $2,085 or 2.5 percent of household income, whichever is greater by 2016 and beyond. The
requirement to have coverage can be waived for several reasons, including financial hardship or religious beliefs.
Millions of additional people will qualify for Medicaid or federal subsidies to buy insurance under the law.
I get my health coverage at work and I'd like to keep my current plan. Will I be able to do that? How will my plan be
affected by the health law?
If you get insurance through your job, it is likely to stay that way. But, just as before the law was passed, your
employer is not obligated to keep the current plan and may change premiums, deductibles, co-pays and network coverage.
You may have seen some law-related changes already. For example, most plans
now ban lifetime coverage limits and include a
guarantee that an adult child up to age 26 who can't get health insurance at a
job can stay on her parents' health plan.
What are some other parts of the law that are now in place?
You are likely to be eligible for
preventive services with no out-of-pocket costs, such as breast cancer screenings
and cholesterol tests.
can't cancel your coverage once you get sick – a practice known as "rescission" –
unless you committed fraud when you applied for coverage.
pre-existing conditions cannot be denied coverage (this will apply to adults in
Insurers will have to provide rebates to consumers if they spend less than 80 to 85 percent of premium dollars on medical
Some existing plans, if they haven't changed significantly since passage of the law, do not have to abide by certain
parts of the law. For example, these "grandfathered"
plans can still charge beneficiaries part of the cost for preventive services.
If you're currently in one of these plans, and your employer makes significant changes, such as raising your
out-of-pocket costs, the plan would then have to abide by all aspects of the health law.
I want health insurance but I can’t afford it. What will I do?
Depending on your income, you might be eligible for Medicaid, the state-federal program for the poor and disabled.
Currently, in most states nonelderly adults without minor children don't qualify for Medicaid.
But beginning in 2014, anyone with an income at or lower than 133 percent of the federal poverty level, (which currently
would be $14,856 for an individual or $30,656 for a family of four) will be eligible for Medicaid (based on current poverty guidelines).
What if I make too much money for Medicaid but still can't afford to buy insurance?
You might be eligible for government subsidies to help you pay for private insurance sold in the state-based insurance
exchanges, slated to begin operation in 2014. Exchanges will sell insurance plans
to individuals and small businesses.
These premium subsidies will be available for individuals and families with incomes between 133 percent and 400 percent
of the poverty level, or $14,856 to $44,680 for individuals and $30,656 to $92,200 for a family of four (based on current poverty guidelines).
Will it be easier for me to get coverage even if I have health problems?
Insurers will be barred from rejecting applicants based on health status once the exchanges are operating in 2014.
I own a small business. Will I have to buy health insurance for my workers?
No employer is required to provide insurance. But starting in 2014, businesses with 50 or more employees that don't
provide health care coverage and have at least one full-time worker who receives subsidized coverage in the health insurance exchange will
have to pay a fee of $2,000 per full-time employee. The firm's first 30 workers would be excluded from the fee.
However, if you have a
firm with 50 or fewer people you won't face any penalties.
In addition, if you own a small business, the health law offers a tax credit to help cover the cost. Employers with 25 or
fewer full-time workers who earn an average yearly salary of $50,000 or less today can get tax credits of up 35 percent of the cost of
premiums. The credit increases to 50 percent in 2014.
I'm over 65. How does the legislation affect seniors?
The law is narrowing a gap in the Medicare Part D prescription drug plan known as the "doughnut
hole." That's when seniors who have paid a certain initial amount in prescription costs have to pay for all of their drug costs
until they spend a total of $4,700 for the year. Then the plan coverage begins again.
coverage gap will be closed entirely by 2020. Seniors will still be responsible
for 25 percent of their prescription drug costs.
The law also has expanded Medicare's coverage of preventive services, such as screenings for colon, prostate and breast
cancer, which are now free to beneficiaries. Medicare will also pay for an annual wellness visit to the doctor.
The health law reduced the federal government's payments to Medicare Advantage plans, run by private insurers as an
alternative to the traditional Medicare. Medicare Advantage costs more per beneficiary than traditional Medicare. Critics of those payment
cuts say that could mean the private plans may not offer many extra benefits, such as free eyeglasses, hearing aids and gym memberships that
they now provide.
Will I have to pay more for my health care because of the law?
No one knows for sure. Even supporters of the law acknowledge its steps to control health costs, such as incentives to
coordinate care better, may take a while to show significant savings. Opponents say the law’s additional coverage requirements will make
health insurance more expensive for individuals and for the government.
That said, there are some new taxes and fees. For example, starting in 2013, individual with earnings above $200,000 and
married couples making more than $250,000
will pay a Medicare payroll tax of 2.35 percent, up from the current 1.45
percent, on income over those thresholds. In addition, higher-income people will face a 3.8 percent tax on unearned income, such as dividends
Starting in 2018, the law will also impose a 40 percent excise tax on the portion of most employer-sponsored health
coverage (excluding dental and vision) that exceeds $10,200 a year and $27,500 for families. The tax has been dubbed a "Cadillac" tax because
it hits the most generous plans.
Has the law hit some bumps in the road?
Like any major piece of legislation, some aspects have not worked out as well as its authors intended.
For example, the law created high-risk insurance pools to help people purchase health insurance. But enrollment in the
pools has been less than expected. As of March 31, 61,619 people had signed up for the high-risk pools, but the program, which began in June
2009, was initially expected to enroll between 200,000 to 400,000 people. The cost and the requirements have been difficult for some to meet.
For example, applicants must be uninsured for six months because of a pre-existing medical condition before they can join
a pool. And because participants are sicker than the general population, the premiums are higher.
Enrollment has increased since the summer, after the
premiums were lowered in some states by as much as 40 percent and some states
stepped up advertising.
Another feature of the law that hasn't worked as envisioned is its long-term care provision. The Community Living
Assistance Services and Supports program (CLASS Act) was designed for people to buy federally guaranteed insurance that would have helped
consumers eventually cover some long-term-care costs. But last fall, federal officials
effectively suspended the program even before it was slated to begin, saying they
could not find a way to make it work financially.
Mary Agnes Carey, KHN Staff Writer
>> Check KHN for updates
to this report.
information is reprinted from
kaiserhealthnews.org with permission from the Henry J.
Kaiser Family Foundation. You can view the entire Kaiser
Daily Health Policy Report, search the archives and sign up
for email delivery. © Henry J. Kaiser Family Foundation. All
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