1. The Health Care Law:
Things You Need to Know

2. Welcome
Welcome to this session on “The Health Care Law: Things You Need to Know.”
As you may have heard, in late June 2012, the Supreme Court announced their decision about the status of the Health Care Law.
If you are like many people, you may have questions about what the health care law means for you. Some of the improvements and changes in the law are in effect now. Others will phase in over several years. By understanding what is in the law, you can make the best decisions for yourself and your family.

3. Agenda Supreme Court’s Ruling What the health care law means for:
People with health insurance
People who are uninsured or
buy their own coverage
Small business owners
People with Medicare
People receiving long-term care
AARP’s Health Law Guide
Today’s session is intended to give you an overview of the key improvements within the health care law. We realize there is, and will continue to be, a lot to talk about regarding the health care law. This presentation is a starting point to get you acquainted with the law and some of the key provisions.
Here is what today’s session will cover:
A brief overview of the Supreme Court’s decision about the law
We will go over what the law means for several groups of people:
Those who have insurance
Those who do not have coverage or who buy coverage on their own
Small business owners
People with Medicare
Those who are receiving long-term care
And we will introduce our brand new online resource, AARP’s Health Law Guide
We will point out when the various provisions of the law go into effect, and
Where you can go for more resources and information

4. Supreme Court Decision
The Supreme Court ruled that the majority of the critically important provisions of the ACA are constitutional
As I mentioned in the introduction, the Supreme Court announced their decision on the health care law in late June.
The Supreme Court ruled that the majority of the critically important provisions of the Affordable Care Act are constitutional.

5. The individual mandate is constitutional
Supreme Court Decision
The individual mandate is constitutional
States have the option to expand Medicaid
So, what does this mean in terms of the various provisions within the law?
It means that the court ruled that the individual mandate – the provision that requires all Americans to have health insurance – is constitutional. The only part of the Affordable Care Act the court found unconstitutional was the requirement that states must expand Medicaid to reach more low income people. What this means is that states have the option to expand Medicaid, if they choose to do so.
We’ll talk about how Medicaid works a little bit later on in the presentation.

6. What’s Next? You may be wondering what’s next?
The health care law has already helped millions of people. Let’s start by discussing how the law will continue to provide benefits and protections for different groups of people - specifically, people with health insurance, people without health insurance, people with Medicare, and people planning for long-term care.

7. People with Health Insurance
Things You Need to Know
The first group we’re going to discuss are people who currently have health insurance.

8. Ends unfair insurance practices
Insurance companies can’t drop coverage if you get sick (Now)
Insurance companies have to justify increases to premiums (Now)
Children under age 19 can’t be denied coverage for a pre-existing condition (Now)
The law makes a number of changes that protect you from discriminatory insurance practices. All of these are in effect right now.
For instance, as long as you continue to pay your premiums, health insurance companies cannot drop your health coverage if you become sick or disabled.
There are also protections in place to limit increases to insurance premiums. Insurance companies must now justify any rate increase of 10% or more.
Another important change is that children under age 19 cannot be denied health insurance because of a pre-existing condition, such as cancer, diabetes and heart disease. This provision will also extend to adults by 2014.

9. Eliminates lifetime and annual coverage limits
Insurance companies can’t place lifetime limits on your coverage (Now)
Insurance companies can’t place annual limits on your coverage (2014)
The law also makes changes in the limits that an insurance company can place on your coverage. Before the law was passed, some insurers could limit how much they pay for your care during the year and over your lifetime. So, once your insurance coverage ran out, you would either have to pay out-of-pocket for all of your medical expenses, or go without medical care.
Because of the health care law, insurance companies will no longer be allowed to limit how much they will pay for medical benefits over your lifetime—giving you peace of mind that your benefits won’t run out when you need them the most. They also won’t be allowed to limit how much they will pay for your medical benefits over the course of a year.
The ban on lifetime limits is in effect now, and the ban on annual limits starts in 2014.

10. Requires coverage for preventive services
Applies to most insurance plans
Covers more preventive care
Mammograms
Immunizations
Screenings for cancer
or diabetes
Another change under the law is in the area of preventive health services. Most insurance plans, including Medicare, must now cover proven preventive benefits such as immunizations and screenings for diabetes and certain cancers. This includes mammograms and colonoscopies.
Again, these benefits are in effect now. So, please check with your insurance plan to see which of these services are covered at no cost to you.

11. People Who Are Uninsured Or Buy Their Own Coverage
Things You Need to Know
As we all know, there are many Americans who either do not have health insurance, or who have to buy their own insurance. ….. (and if you ever have to buy insurance on your own, it can be pretty confusing to figure out how to compare plans and prices).
Let’s look at how the health care law will affect this group.

12. Creates Health Insurance Exchanges
Makes it easier to buy health insurance
Offers health insurance plans by 2014
If you are uninsured or buy your own coverage, the health care law will make it easier for you to buy health insurance. If you’re an uninsured individual, or you own a small business, or you are self-employed, you will be able to purchase health insurance through an exchange. An exchange is an on-line marketplace – or, another way to think of it is an online shopping mall, were you will be able to compare the benefits and costs of health plans side by side and select the plan that works best for you and your family, or small business.
The exchanges must begin offering health insurance in every state by 2014.

13. Creates Health Insurance Exchanges
Offers comprehensive benefits
Several levels of coverage
Makes it easier to compare benefits and costs
All health insurance plans in the exchanges will offer comprehensive benefits. These may include benefits such as medical, mental health, prescription drug, and rehabilitation services. When insurance plans become available through the exchanges in 2014, you will be able to pick among several levels of coverage. Exchanges will make it easier for you to compare health insurance plan benefits and costs.

14. Provides Help Paying for Insurance
Starting 2014
For health insurance purchased through an exchange
One of the hallmarks of the law is that it provides help with paying insurance premiums for those who cannot afford coverage. Starting 2014, you may be able to get tax credits to help you pay your premiums for health insurance purchased through an exchange.

15. Extends coverage to young adults
Adult children can stay on your policy until age 26
Adult children can be covered even if they:
Live with you
Are married
Are no longer in school
As you know, there are many young adults who are no longer covered by a family policy or don’t have insurance through their job. In the past, young adults frequently were forced off their parents’ policies once they reached 18 or 21, or graduated from college. But, now, because of the health care law, you may be able to cover your son or daughter on your insurance policy until they reach age 26.
If you currently have your children on your health insurance, you can keep them on your family policy until they reach 26—even if they no longer live with you, are married, and are no longer in school. You do not have to claim them as a dependent on your tax return. However, you will not be able to include their spouse or their children on your policy.
If your adult children are not included on your health insurance and you want them to be—you will be able to add them to your policy -- if your insurer provides family coverage.
However, if you’re adding adult children to your policy, their coverage may not begin until the start of your new insurance plan year.
Insurance companies and employer-based plans are not required to offer family plans. If you are in a group plan that does not provide family coverage, you will not be able to include your adult children on your policy. Also, if your adult children have access to coverage through their jobs, you will not be able to add them to your plan. To be insured, they will have to take advantage of their employer’s health plan.

16. Option for States to Expand Medicaid
Starts in 2014
Your state has the option to expand coverage to more people
Must meet income limits to be eligible
Another way the health care law can help uninsured people is through the expansion of the Medicaid program. Again, it is up to each sate to decide if they wish to allow more people to get Medicaid.
Remember, Medicaid is a very different program than Medicare.
Briefly, Medicaid is a health insurance program for low-income people that is jointly funded by the federal government and the states. It currently provides health coverage to children, older persons, disabled persons, and others.
Starting in 2014, if your state decides to expand their Medicaid program, you may be able to enroll in Medicaid. You would need to meet the income limits which are currently about $15,000 a year for an individual and about $21,000 per year for a couple. Note that these figures will most likely change in 2014 as they do every year.

17. Provides temporary coverage for people with pre-existing conditions
“Pre-Existing Condition Insurance Plan” (PCIP)
You must be uninsured for at least 6 months and have a pre-existing health condition
Information about the PCIP in your state is available NOW!
What about coverage for people with pre-existing conditions?
I mentioned a bit earlier….children under age 19 cannot be denied health insurance because of a pre-existing condition, such as cancer, diabetes and heart disease. And this will apply to adults by 2014.
In the meantime, if you have been uninsured and have a pre-existing condition, you may be able to get temporary health insurance coverage. This coverage is often referred to as the “Pre-existing Condition Insurance Plan (PCIP).” Information about this coverage is available in your state now.
To be eligible for the Pre-existing Condition Insurance Plan in your state, you must have been uninsured for at least 6 months and have a pre-existing medical condition.
We really encourage you to take advantage of this program, if you are eligible to do so.

18. Provides temporary coverage for people with pre-existing conditions
Covers a range of benefits
Covers pre-existing conditions
Ends when exchanges start in 2014
The Pre-existing Condition Insurance Plan covers a range of benefits, including primary and specialty care, hospital care and prescription drugs.
All of these health plans must cover pre-existing medical conditions. Premiums will be based on a number of factors, such as your age, and the state where you live.
The temporary coverage available through the Pre-existing Condition Insurance Plans will end in January 2014 once the state-based health insurance exchanges begin offering coverage.
For more information on the pre-existing condition insurance plan in your state visit or call

19. www.pcip.gov This is a screen shot of the pcip.gov website.
To find information on Pre-Existing Condition Insurance Plan in your state, click on “Find Your State.”
Now, let’s talk a bit about how the health care law affects another important group: small businesses owners.

20. Small Business Owners Things You Need to Know
If you’re a small business owner, or know someone who is, you know that it can be a challenge to be able to offer health insurance to employees. Under the health care law, more choices will be available to small businesses. Some small businesses may also qualify for tax credits to offset part of the cost of insurance.

21. More options to offer employees
Businesses with up to 100 employees can buy insurance through the exchanges
Exchanges will offer a range of health plans
Businesses with more than 50 employees may pay a penalty if they do not offer coverage
Let’s start with finding health insurance for employees. Small businesses that do not currently offer employee health insurance will have more options in the future. Starting in 2014, businesses with up to 100 workers may be able to buy insurance for their employees through the new health insurance exchanges.
The exchanges will offer a range of health plans to choose from. All of the plans sold through the exchanges must include standard benefits—such as medical, mental health, prescription drug, and rehabilitation services.
What happens if you’re a small business owner and you don’t offer employee health insurance? Will you be required to offer it? That depends on the number of people who work for you.
If you have fewer than 50 employees, there will be no penalties for not offering health insurance. But as of 2014, businesses with more than 50 employees may have to pay an annual penalty if they do not offer coverage.

22. Tax credits to offset insurance costs
Retroactive to January 1, 2010
Must have 25 or fewer employees with average wages under $50,000
Must pay at least 50% of cost
of insuring employees
Here’s some good news for small business owners: You may be able to get tax credits to offset part of the cost of offering health insurance to your employees. It’s estimated that 2.8 to 4 million small businesses will be eligible for the credits.
The tax credits are retroactive to January 1, 2010.
To be eligible for a tax credit:
You must have 25 or fewer employees whose average annual wage is under $50,000,
and
You must pay for at least 50% of the cost of health care coverage for your employees.
The amount of the tax credit depends on how many employees you have and their average wage.
You can find more details about the small business tax credits by visiting the IRS website, Another helpful website is where you can find a Healthcare Tax Credit Calculator and other useful information.

23. Other benefits for businesses with up to 100 employees
Cafeteria plans
As of 2011, can offer “simple cafeteria” plans
Helps employees save for future medical expenses
Grants for wellness programs
$200 million available (as of 2011)
Administered by US Dept. of Health & Human Services
There are two other benefits for small businesses that we want you to know about:
The first has to do with cafeteria plans. As of (2011), businesses with up to 100 employees can offer what are called “simple cafeteria” plans. These plans allow employees to save part of their paycheck in an account that they can use to pay for future medical expenses. This saves your employees money because they do not have to pay taxes on the money they contribute to this account.
The other benefit is the opportunity to apply for a wellness grant. The purpose of these grants is to help small businesses set up workplace wellness programs. Again, as of (2011), a total of 200 million dollars in grants will be available over a five-year period.
The grants will be administered by the U.S. Department of Health and Human Services (HHS).

24. People With Medicare Things You Need to Know
Let’s turn now to people with Medicare. What changes does the health care law have in store for this group?

25. For People with Medicare
Protects guaranteed Medicare benefits
Improves Medicare benefits
Lowers out-of-pocket costs
for prescription drugs
The law aims to improve Medicare by requiring Medicare to spend more wisely.
If you have Medicare, your guaranteed Medicare benefits are protected. This includes doctor and hospital visits, and rehabilitation services. This is true whether you have Original Medicare, which includes Part A and Part B, or a Medicare Advantage plan.
You will also receive improved benefits. For example, improvements to Medicare will lower your out-of-pocket costs for prescription drugs.

26. Lowers out-of-pocket drug costs
The doughnut hole will gradually disappear
2012: 50% discount on brand name drugs; 14% discount on generics
By 2020:
Coverage gap will disappear
Part D cost sharing will remain
Before the law was passed, you would have had to pay all of your prescription drug costs while you were in the doughnut hole. If you reach the Medicare Part D doughnut hole this year, you’ll get a 50% discount on brand-name prescription drugs and a 14% discount on generic prescription drugs while you are in the coverage gap.
The gap will gradually narrow until it disappears in However, even after the gap is gone, everyone with Part D will still have the same level of cost sharing -- about 25% -- from the time you meet your deductible until the time you reach catastrophic coverage.
Catastrophic coverage remains in place even after the coverage gap goes away. Catastrophic coverage starts when your total out-of-pocket drug costs have climbed to $4,700 in After that point, you only have a 5% co-payment.

27. Medicare Drug Coverage 50% discount for Brand Name and 14% for Generic
Initial Benefit
Doughnut Hole
Catastrophic Benefit
50% discount for Brand Name and 14% for Generic
You pay: Deductible and 25% of drug costs
You pay: 5% of drug costs
Let’s take a minute to review the Medicare Part D Coverage Gap or “Doughnut Hole”. I know this can be confusing, so here’s a visual presentation of the doughnut hole that may be helpful.
Starting on the left side, this is your initial benefit period where you pay your Part D deductible and about 25% of your drug costs. Moving to the middle, once you reach the initial coverage limit, you are in what is commonly called the "Coverage Gap” or "Doughnut Hole,". You reach the doughnut hole when you exceed a certain amount, which in 2012 is $2,930.
What is new this year (2012), is that your plan will pay 50% of the cost of brand-name prescription drugs and 14% of your generic prescription drug costs while you are in the doughnut hole. This is a change that came about as a result of the health care law. By the way, exactly how much you pay out of pocket for each drug while you are in the doughnut hole will vary widely depending on the Part D plan you’ve chosen and the price your plan has negotiated with the companies that manufacture your drugs.
When your total out-of-pocket expenses for drugs on your plan’s approved drug list reaches $4,700, you reach the "Catastrophic Coverage " benefit.  From then until the end of the year, you pay roughly 5% of your drug costs under the catastrophic benefit.
Just to clarify a bit …. your out of pocket costs include your deductible, copayments, and coinsurance. But this does not include your Part D premiums.

28.
You can use AARP’s Doughnut Hole Calculator to find out if or when you will hit the coverage gap and you’ll also find recommendations for less expensive drugs.
When you click on the Doughnut Hole Calculator, you just enter your zip code and follow the steps. It’s easy to use and shows you to ways to save right now on your drug costs. It’s at

29. Other Changes to Medicare Part D
Income-related premiums
Income levels start at
$85,000 for a single person
$170,000 for married couples
Will apply to those who have
Part D drug coverage in 2011
There is one more change related to Medicare that you need to know about. It has to do with premiums for people with higher incomes.
As in prior years, you pay a higher monthly premium for Medicare Part B if your income is above a certain level.
The income level starts at $85,000 for a single person or $170,000 for married couples filing joint tax returns.
Income-related premiums now also apply to those who have Part D prescription drug coverage. This provision went into effect in The income levels for Part D are the same as those just mentioned for Part B -- $85,000 for an individual or $170,000 for married couples filing jointly.

30. Covers more preventive services
Adds a free yearly wellness visit
Expands coverage for preventive care
No copayments or deductibles for Medicare-approved preventive care
You will no longer have to pay for Medicare-approved preventive care services. You will also be able to work with your doctor on a personalized prevention plan to keep you as healthy as possible. This means that health problems can be detected sooner and treated more quickly.
These are just a few of the examples of the new free preventive benefits. They include:
A free yearly wellness visit. Screenings for diabetes and certain cancers. This includes mammograms, colonoscopies, and other preventive screenings.
These preventive services are in addition to the free “Welcome to Medicare” visit available to every new person with Medicare during the first year of entering the Medicare program.
The Secretary of Health & Human Services may also add other tests, screenings, or counseling, as we move forward in the future.
You will not have to pay co-payments or deductibles for these Medicare-approved preventive care services.
Screenings currently available, such as pap smears and prostate exams, will continue to be available.
Call Medicare at or visit to see which of the Medicare-approved preventive care services are covered at no cost to you. Your copy of the booklet Medicare and You has a long list of all the preventive screenings now available. You can get the booklet by calling Medicare at
If you are in a Medicare Advantage plan, check with your plan to see if you’ll have co-payments or deductibles for any screenings or tests.
Call Medicare at

31. People Receiving Long-Term Care
Things You Need to Know
Many of us are concerned about long-term care. Not only for ourselves, but for our family as well.

32. More information about nursing homes
Makes it easier to file complaints
Extends financial protections
You now have easier access to more information on nursing homes to help you select a nursing home or monitor the care of a friend or a loved one. You will be able to get information about…
who owns the nursing home,
how much the nursing home spends on resident care compared to administrative costs,
staff turn-over rates, and
the number of complaints and violations.
Your state will be required to have a process in place to resolve complaints about nursing homes. The nursing home must notify you that your complaint has been received and how it has been resolved. Nursing homes in your state will have to meet new requirements if the facility closes. Residents and their families must be told of the closure far enough in advance so they can make other plans for relocation.
If you are married to someone on Medicaid who is receiving care services at home, you will have the same protections for your income and other resources as do spouses of those on Medicaid who live in a nursing home. This provision starts in 2014.
You will find more information on Medicare’s Nursing Home Compare website medicare.gov/NHcompare.
(NOTE: NEXT SLIDE IS A SCREEN SHOT OF the NURSING HOME COMPARE TOOL)

33. On the Nursing Home Compare site, you can search by the name of the nursing home, or by city, county, state or ZIP code.
That website is medicare.gov/NHcompare.

34. Key points to remember:
Increases consumer protections
Makes health insurance more
accessible
Improves and expands Medicare-covered benefits
Increases protections for people in nursing homes
There’s a lot to absorb about the health care law. Here are some key points to remember:
The law :
Increases consumer protections
Makes health insurance more accessible and affordable—for individuals and for small businesses
Improves and expands the benefits you receive under Medicare
Increases protections for people in nursing homes
Keep in mind that the health care law will be phased in over the next few years. AARP will keep you informed as the various parts of the law go into effect.

35.
The health care law will be phased in over a number of years. AARP will keep you informed as the various parts of the law go into effect. And the best way to stay informed is to use AARP’s Health Law Guide. The guide is a one-of-a-kind online tool that explains what the health care law means for you and your family, now and in the future.
AARP’s Health Law Guide is available in English and Spanish. It is designed to help Americans of all ages understand benefits available currently and in the future under the Affordable Care Act (ACA), so they can make the best decisions for themselves and their families. The Guide can be found by visiting

36.
The Health Law Guide provides real-time information.  Through an interactive timeline you can learn about the impact the law has now and when it fully goes into effect in 2014.  

37.
AARP’s Health Law Guide is fast and easy to use. By answering six simple questions, you will get a tailored report outlining coverage details based on an individual’s existing health care coverage or what other health coverage the individual may be eligible to get.

38. Questions and Answers
It’s time to answer your questions.

39. For more information The health care law Medicare
(Spanish)
Medicare
Insurance plans in your state
State Health Insurance Assistance Program
Pre-existing Insurance Plan
You are bound to have more questions as the health care law is implemented.
AARP is working hard to provide you with updated information, so please visit aarp.org/healthlawguide .
Go to healthcare.gov for information on temporary insurance for pre-existing conditions and other aspects of the health care law.
You can also find answers to your Medicare questions at medicare.gov or by calling Medicare at (800) 633–4227.
Finally, you can find insurance information for your state at SHIPtalk.org or you can call
Visit pcip.gov for those who want more information about the Pre-existing insurance plan in your state. Or call

40. Has the Health Care Law helped you?
Share your personal story
(Please promote the story database)
Has the health care law helped you? If you have a story that you want to share, AARP is listening. We are collecting personal stories of people who have already benefited from the health care law. Personal stories illustrate how the law impacts our members and their loved ones. Your stories help us learn what is important to you, so we can continue to serve you and your family. Stories also help get the word out to the media, legislators, and other AARP members about the importance of quality, affordable health care.
Your story may inspire others.

41.
Thank you for participating in today’s presentation.