Affordable And Quality Health Care For New Jersey's Seniors

October 25, 2010 4:49 pm ET

The Affordable Care Act delivers comprehensive health care reform to 1.1 million seniors in New Jersey. The law improves the quality and scope of health care by closing Medicare's prescription drug benefits gap; empowers seniors to stay in their homes and still receive long-term care services; guarantees comprehensive preventive care coverage; and eliminates insurance company loopholes that have been used to deny coverage. By slashing government waste, fraud, and abuse within the Medicare and Medicaid system, the law not only saves taxpayer dollars but also provides seniors with better coverage.

Improving The Quality Of Medicare

Closing The Medicare Prescription Drug "Donut Hole"

The "Donut Hole" Is The Gap In Drug Coverage When Annual Costs Are Between $2,830 And $6,440. CNN Money reported: "What's the donut hole? In addition to a $310 deductible, Medicare beneficiaries pay 25% of their drug costs until the total reaches $2,830 for the year. Then, they fall into a coverage gap. At that point, enrollees must pay all costs out of pocket until their annual expenses exceed $6,440. After that, seniors pay 5% of drug costs for the rest of the year." [CNN Money, 6/7/10, emphasis added]

The Affordable Care Act Provides $250 In Compensation For Nearly 109,000 New Jersey Seniors Who Are Enrolled In The Medicare Prescription Drug Program And Fell Into The "Donut Hole." According to Wayne Today: "Last year nearly 109,000 Medicare beneficiaries in New Jersey reached the gap in Medicare Part D drug coverage, and they paid the full costs of their prescription drugs, also known as the 'donut hole.' But thanks to health care reform, a beneficiary entering the 'donut hole' will actually see a savings of over $700 next year and over $3,000 by 2020. As part of the bill, beneficiaries will also receive a $250 rebate in 2010, 50 percent discounts on brand name drugs beginning in 2011, and see total closure of the 'donut hole' within 10 years." [Wayne Today, 8/19/10]

Protecting Health Care Benefits For Early Retirees

At Least 135 New Jersey Businesses, Local Municipalities And Labor Organizations Are Providing Early Retirees With Health Benefits Through The Affordable Care Act.  According to "The Early Retiree Reinsurance Program provides $5 billion in financial assistance to employers and unions to help them maintain coverage for early retirees age 55 and older who are not yet eligible for Medicare. ... Savings can be used to reduce employer health care costs, provide premium relief to workers and families, or both." As of October 22, 2010, 135 New Jersey employers were approved to participate in the Early Retiree Reinsurance Program. [, accessed 10/23/10]

Expanding Preventive Care To New Jersey Seniors

Medicare Recipients, The Uninsured, And Seniors With Private Health Insurance Are Eligible For Free Preventive Care Services. The Affordable Care Act automatically extends free preventive care for those enrolled in Medicare. Additionally, CBS News reports that the law "[r]equires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles." By 2018, this requirement applies to all private health insurance plans. [U.S. Department of Health and Human Services, 7/14/10; CBS News, 3/21/10]

Disease Prevention And Screening For:

  • Cancer: Breast, Cervical and Colorectal Cancer
  • Diet: Cholesterol, Obesity and Blood Pressure
  • Bones & General Wellness: Osteoporosis and aortic aneurysm

[U.S. Preventive Services Task Force, August 2010]

Protecting Seniors From Health Insurance Company Tricks That Can Deny Or Rescind Coverage

Prohibiting Insurance Companies From Dropping Coverage Of New Jersey's Seniors. According to the State of New Jersey Department of Banking and Insurance: "Any provision of the [policy] that describes the right of [the insurer] to rescind or void the [policy] or to rescind the coverage of an individual under the [policy] is amended to permit [the insurer] to rescind or void the entire [policy] or the coverage of an individual only if (1) the individual (or a person seeking coverage on behalf of the individual) performs an act, practice, or omission that constitutes fraud; or (2) the individual (or a person seeking coverage on behalf of the individual) makes an intentional misrepresentation of material fact." [N.J. Department of Banking and Insurance, 8/27/10]

Eliminating Lifetime Price Caps On Insurance Coverage. The Affordable Care Act prohibits insurance companies from imposing a lifetime price cap on health care coverage. AARP explains that the law "phases out these annual limits over a period of three years: in the first year, insurers must cover medical expenses up to at least $750,000. That coverage rises to $1.45 million after Sept. 23, 2011 and increases to $2 million after Sept. 23, 2012. Limits will be completely banned starting Jan. 1, 2014." [, 8/23/10]

Delivering A More Efficient Health Care System

The Affordable Care Act Cracks Down On Waste, Fraud, And Abuse. From The Hill: "Healthcare providers would be subject to new screening measures based on their level of risk to federal health programs, under new proposed regulations released by the Centers for Medicare and Medicaid Services. The fraud, waste and abuse prevention measures were called for in the new healthcare reform law. [...] Improper payments cost federal health programs about $55 billion a year." [The Hill, 9/20/10]

According To The U.S. Department Of Health And Human Services, The Proposed Rules Will:

  • "Establish the requirements for suspending payments to providers and suppliers based on credible allegations of fraud in Medicare and Medicaid;
  • Establish the authority for imposing a temporary moratorium on Medicare, Medicaid, and CHIP enrollment on providers and suppliers when necessary to help prevent or fight fraud, waste, and abuse without impeding beneficiaries' access to care.
  • Strengthen and build on current provider enrollment and screening procedures to more accurately assure that fraudulent providers are not gaming the system and that only qualified health care providers and suppliers are allowed to enroll in and bill Medicare, Medicaid and CHIP;
  • Outline requirements for states to terminate providers from Medicaid and CHIP when they have been terminated by Medicare or by another state Medicaid program or CHIP;
  • Solicit input on how to best structure and develop provider compliance programs, now required under the Affordable Care Act, that will ensure providers are aware of and comply with CMS program requirements."

[U.S. Department of Health and Human Services, 9/20/10]

Improving The Quality Of Long-Term Care

Helping Seniors Stay In Their Homes And Receive Long-Term Care. The Affordable Care Act includes the Community Living Assistance Services and Supports (CLASS) provision that will be implemented in 2012. According to the National Council on Aging: "CLASS ... is a new public insurance program designed to help people pay for long-term care at home. Full- and part-time workers can choose to participate by paying into the program through voluntary payroll deductions. Non-working retirees are not eligible for the program. A person is eligible to receive CLASS benefits if he or she can't perform multiple basic living activities-such as eating, dressing, or bathing-or has certain mental impairments such as Alzheimer's disease. To be eligible for benefits, you also must pay premiums for five years." [National Council on Aging, 7/22/10]

  • Seniors Enrolled In CLASS May Be Eligible To Receive "Advocacy Counselors" Who Will Help Enrollees Navigate The System. According to the National Health Policy Forum: "[E]ach [CLASS] enrollee is to be assigned (as needed) an advocacy counselor who is to provide beneficiaries with information on ways to access the CLASS appeals system, assistance on annual recertification and notification systems, and other assistance required to be offered under HHS regulations." [National Health Policy Forum, 6/9/10]

Eliminating Abuse At Long-Term Care Facilities. The Affordable Care Act provides "a dedicated source of federal funding for Adult Protective Services offices - state agencies that provide services to abused, neglected, or exploited seniors and people with disabilities." In addition, the law expands a program that checks applicants who would work directly with those in long-term care against abuse and neglect registries. According to Families USA, "the pilot program prevented more than 9,500 people with histories of abuse or violent criminal records from ever working with seniors or people with disabilities. This successful program will now be conducted in every state, ensuring that people with a history of neglect or violence are not put in a position to take advantage of, or harm, our seniors and people with disabilities." [Families USA, October 2010]

Improving Government Services And Quality Of Care For The Elderly. The Affordable Care Act provides additional funding to the Aging and Disability Resource Center, which "play[s] a critical role in supporting health and long-term care reform by improving the ability of State and local governments to effectively manage the system, monitor program quality, and measure the responsiveness of State and local systems of care." [U.S. Department of Health and Human Services, 9/26/10; Centers for Medicare and Medicaid Services, 5/20/10]