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Health Reform Provisions Taking Effect in 2011

Posted Jan 02 2011 9:14pm

happy_new_year_2011-yuval-y1 As we begin 2011, it may be of some help to look at which aspects of the new Health Reform Law(s) are scheduled to take effect this year. Kaiser Family has a fairly nifty and easily read sortable list delineated by year and area; the Wall Street Journal Health Blog has a brief but interesting article complete with links.

Highlights for 2011 include the 80 or 85% loss ratio mandate for insurers and free preventative care for seniors; in the pharm world we can look forward to a shrinking of “the donut hole,” federal subsidies for generics, and FSAs no longer paying for over the counter medicines; and lest we forget, that 3 p.m. trip to the vending machine for some form of sugar will become laden with a better informed guilt as vending machines and chain restaurants will need to post calorie and nutritional info. For a 2011 timeline authored by the Obama administration, see below, courtesy of Health :



  • Offering Prescription Drug Discounts. Seniors who reach the coverage gap will receive a 50 percent discount when buying Medicare Part D covered brand-name prescription drugs. Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020. Effective January 1, 2011. Download a brochure to learn more (PDF, 3.6 MB)
  • Providing Free Preventive Care for Seniors. The law provides certain free preventive services, such as annual wellness visits and personalized prevention plans for seniors on Medicare.  Effective January 1, 2011.
  • Improving Health Care Quality and Efficiency. The law establishes a new Center for Medicare & Medicaid Innovation that will begin testing new ways of delivering care to patients. These methods are expected to improve the quality of care, and reduce the rate of growth in health care costs for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Additionally, by January 1, 2011, HHS will submit a national strategy for quality improvement in health care, including by these programs.  Effective no later than January 1, 2011.
  • Improving Care for Seniors After They Leave the Hospital. The Community Care Transitions Program will help high risk Medicare beneficiaries who are hospitalized avoid unnecessary readmissions by coordinating care and connecting patients to services in their communities. Effective January 1, 2011.
  • Introducing New Innovations to Bring Down Costs. The Independent Payment Advisory Board will begin operations to develop and submit proposals to Congress and the President aimed at  extending the life of the Medicare Trust Fund.  The Board is expected to focus on ways to target waste in the system, and recommend ways to reduce costs, improve health outcomes for patients, and expand access to high-quality care.  Administrative funding becomes available October 1, 2011.


  • Increasing Access to Services at Home and in the Community. The new Community First Choice Option allows States to offer home and community based services to disabled individuals through Medicaid rather than institutional care in nursing homes.  Effective beginning October 1, 2011.


  • Bringing Down Health Care Premiums. To ensure premium dollars are spent primarily on health care, the new law generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement. For plans sold to individuals and small employers, at least 80% of the premium must be spent on benefits and quality improvement. If insurance companies do not meet these goals, because their administrative costs or profits are too high, they must provide rebates to consumers. Effective January 1, 2011.
  • Addressing Overpayments to Big Insurance Companies and Strengthening Medicare Advantage. Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than is spent per person in Traditional Medicare. This results in increased premiums for all Medicare beneficiaries, including the 77 percent of beneficiaries who are not currently enrolled in a Medicare Advantage plan. The new law levels the playing field by gradually eliminating this discrepancy.  People enrolled in a Medicare Advantage plan will still receive all guaranteed Medicare benefits, and the law provides bonus payments to Medicare Advantage plans that provide high quality care.  Effective January 1, 2011. Download a brochure to learn more (PDF)

Photo credit: Yuval Y via Wikimedia Commoons.

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