| Impact on Medicare |
Final Health Reform Law (Senate Bill and Reconciliation) * |
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| Prescription Drugs |
Requires 50 percent discount on brand-name drugs in the doughnut hole, starting in 2011.Phases out the doughnut hole completely by 2020, decreasing the share of costs paid by consumers in the coverage gap until it reaches the standard 25 percent. * |
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| Preventive Services |
Eliminates deductibles and coinsurance for preventive services recommended by the U.S. Preventive Services Task Force.Provides coverage of annual wellness visit and personalized prevention plan at no charge. * |
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| Doctors | Provides 10 percent bonus for primary care. * |
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| Care Coordination |
Provides incentives for doctors to join Accountable Care Organizations that coordinate care from specialists and improve patient health. * |
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| Hospitals and other facilities |
Saves $156 billion over ten years by reducing annual payment increases. Provides incentives to reduce readmissions due to infections or other preventable causes. * |
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| Private Medicare Advantage Health Plans |
Saves $140 billion over ten years by pegging payment to costs under Original Medicare. Provides bonus payments to plans that provide high-quality care based on specific performance standards.Prohibits plans from charging enrollees more than Original Medicare for certain medical services.
Limits plan profits and administrative expenses to 15 percent of Medicare payments and enrollee premiums. Creates single Annual Enrollment Period (AEP) for drug and health plan changes from October 15 – December 7. Allows Medicare Advantage enrollees to enroll in Original Medicare during first 45 days of the new year. |
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| Means Testing | Raises drug plan premiums for individuals earning over $85,000 and couples earning over $170,000. Freezes inflation indexing for Medicare-related premiums for people with high incomes. * |
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| Assistance for Low-Income People with Medicare |
Eliminates prescription drug co-payments for certain Medicaid recipients receiving home- or community-based long-term care.* | |
| Medicare Part A Payroll Tax | Increases the Medicare Part A payroll tax by 0.9% for individuals earning over $200,000 and couples earning over $250,000. Adds a 3.8% tax on certain unearned investment income for individuals earning over $200,000 and couples earning over $250,00. |