More Answers to Your Questions About Health Care Reform

The WebMD audience was invited by the White House to ask questions about health care reform following the President’s State of the Union Address. We took your questions to a live roundtable discussion with Health and Human Services Secretary Kathleen Sebelius. You posted a tremendous number of questions leading up to the event, and we weren’t able to get to all of them, so we’ve asked the Secretary to address a few more of your most common concerns.

Here are her responses to your questions:

How are the new exchanges going to work? -Mary C., Iowa

Exchanges are “marketplaces” that will allow you to compare plans in your state based on price and quality. When implemented in 2014, they’ll be a “one-stop” shop to find and compare affordable, quality health insurance options. In implementing the health insurance Exchanges, HHS is partnering with States to take the often complicated process individuals and small businesses face in purchasing insurance on their own and turn it into a simple, easy-to-navigate experience that benefits consumers rather than insurance companies.

Exchanges will lower costs by increasing competition among private insurance plans through greater comparative shopping and more informed consumers. And by pooling them together, Exchanges will give small businesses the purchasing power that large businesses enjoy today. In addition, individuals and families buying insurance through an Exchange may qualify for tax credits to help pay for premiums and reduce their out-of-pocket payments; small businesses buying through the Exchange will have access to tax credits to help make premiums contributions for their employees. Consumers who choose to use them will also have access to a wide range of customer assistance benefits – including information about prices, quality, and physician and hospital networks – to help make the best choice for themselves, their families, or their employees.

Why won’t you allow across state competition? -Lyn

The Affordable Care Act does allow insurance companies to sell across states lines through interstate compacts, which means states have to agree to the sale of insurance by out-of-state companies. And in fact, state Exchanges may encourage more insurance companies to enter new markets, thereby increasing competition and choice beyond what Republicans claim will be the case under their proposal.

I would like to know when there will be less restrictions on mental health sessions. I am always baffled why an insurance company is allowed to limit how many therapy sessions a patient in need can have a year. -Judith

Last year, the Obama Administration issued new rules that prohibit group health insurance plans—typically offered by employers—from restricting access to care by limiting mental health benefits and requiring higher patient costs than those that apply to general medical or surgical benefits. The rules implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). In other words, the MHPAEA states that a group health plan may not impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical surgical benefits.

The Affordable Care Act also takes steps to help people access the mental health services they need:

Right now, if you haven’t been able to find health insurance due to a pre-existing mental health condition, you may be able to access the new Pre-Existing Condition Insurance Plan.

Starting in 2014, substance abuse or mental illness can no longer be used by insurers to deny coverage as a “pre-existing condition” – and insurers also won’t be able to use those conditions to raise your premiums.

Also in 2014, mental health and substance use disorder services will be part of the essential benefits package, a set of health care service categories that must be covered by certain plans, including all insurance policies that will be offered through the Exchanges, and most coverage in Medicaid.

These reforms all work to make the health insurance marketplace a more accessible, affordable place for people with mental health and substance abuse disorders.

I retired here many years ago. My Medicare barely covers my needs now. What are some of the benefits people with Medicare will start to see this year? -William, Florida

The Affordable Care Act strengthens Medicare in many ways. There are a few new benefits people on Medicare should look for.

As of this year, when you see a Medicare participating physician, you will no longer have out-of-pocket costs for the “Welcome to Medicare” physical exam. For the first time since the Medicare program was created in 1965, Original Medicare covers an annual wellness visit with a participating doctor, also at no cost. This allows Medicare beneficiaries who have been enrolled in Medicare for more than 12 months to meet with their doctors once a year to develop and update a personalized prevention plan as their needs change over time.

In addition to these annual wellness visits, most people with Medicare are able to receive many critical preventive services for free, including certain cancer screenings such as mammograms and colonoscopies.
People with Medicare with high prescription drug costs are also seeing relief. In 2010, we sent more than 3 million $250 rebate checks to help seniors who reached the donut hole in 2010. In 2011, seniors in the donut hole will receive a 50 percent discount for covered brand-name drugs and the Affordable Care Act will reduce prescription drug costs for beneficiaries in the donut hole each year until it is closed in 2020.

Qualifying doctors and other health care professionals who provide primary care to people on Medicare will get a 10 percent bonus for primary care services. This will help ensure that those primary care providers can continue to be there for Medicare patients.

To learn more about the “Welcome to Medicare” physical exam and the annual wellness visit, search for participating doctors in their area, and find other helpful information, contact a trained customer service representative toll-free at 1-800-MEDICARE (1-800-633-4227), or visit www.medicare.gov.