From the Office of State Senator Royce West - District 23

For Immediate Release
CONTACT:  Kelvin Bass, 214-467-0123
June 30, 2010

Start looking for rollout of the health care reform bill

by Royce West
Texas Senate

If they haven’t already, seniors should soon expect to receive a $250 check from the federal government. It’s the rebate promised to seniors who have shelled-out their hard-earning savings and cash for prescription drugs despite having coverage through Medicare or private insurance plans.

Many seniors have painfully become familiar with the “donut hole” in Medicare coverage. Since the advent of Medicare Part D coverage in 2006, recipients have been made to shoulder the full cost of their medications when a pre-determined spending cap was reached; an amount that has actually increased.

Because of the “donut hole” seniors whose total prescription costs exceed the lower threshold of $2,700 no longer receive Medicare benefits until their spending reached the “catastrophic” amount of $6,154; a gap of nearly $3,500. At that point, Medicare kicks back in and pays 95 percent of prescription drug costs. However more costly coverage can be purchased to span the gap.

The first of the $250 checks were scheduled to be issued June 15. And starting in 2011, seniors who hit the donut hole will receive a 50 percent discount on brand name prescription drugs. The healthcare reform legislation has the goal of completely closing the donut hole gap by 2020.

Americans will begin to see even more benefits of the landmark “Patient Protection and Affordable Care Act of 2010" rollout even as some members of Congress and tea party activists call for the law’s repeal. Now, small businesses with less than 25 employees can claim up to 35 percent of the costs paid in employee healthcare coverage in tax credits.

Two more phases of the healthcare law will kick-in by late summer. Parents will find relief in the bill’s provisions that will stop providers from denying coverage to children who have pre-existing conditions. The new law will also allow parents to include single, young adult dependents in their coverage under all existing plans until they turn 26.

By year's end, insurance companies will no longer be able to rescind the coverage of policy holders after they become ill in order to avoid payouts. And insurers will no longer be allowed to place lifetime benefit caps on coverage. The first provisions that will ban annual benefit caps will also phase in over the next few months.

The new law also creates a temporary reinsurance program for early retirees between ages 55-64 that lowers the cost to companies who provide coverage.

On April 30, Gov. Rick Perry announced that Texas will not be the administrator of a program that would provide insurance to those denied coverage due to pre-existing medical conditions and as such, were determined by insurers to be high-risk. Instead, those eligible will be able to purchase coverage through a federally-run high-risk pool.

The U.S. Department of Health and Human Services is now finalizing agreements for a Texas-based plan administrator. However uninsured Texans will be able to apply for the federal high-risk plan as of July 1. The plan will be operational beginning August 1. Application information will be posted on the Texas Department of Insurance website when it becomes available.

For more information, please contact Kelvin Bass at 214-467-0123.