Medicaid

• Medicaid eligibility expansion goes into effect on January 1, 2014
• The Affordable Care Act has expanded Medicaid so the minimum eligibility to be accepted is 133% of the federal poverty line.
• This will allow about 250,000 new individuals to qualify for Medicaid between the ages 19 - 65
• In order to be eligible for Medicaid, individuals need to satisfy federal and state requirements regarding residency, immigration status, and documentation of U.S. citizenship.

Medicare

• Medicare is paying primary care physicians a 10% bonus for primary care services from 2011 through 2015
• Medicare is also paying primary care physicians a 10% bonus if they are practicing in a shortage area, such as rural communities
• The Donut Hole
• (Medicare Part D) Many Medicare Prescription Drug Plans today have a coverage gap. Also known as the "donut hole"
• The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. In 2013, once you and your plan have spent $2,970 on covered drugs (the combined amount plus your deductible), you're in the coverage gap
• Once you have reached the $2,970 limit. Your prescription benefits go down and you are in the gap "Donut Hole".
• While in the "donut hole" the co-pay for the cost of medicine rises to 47.5% for brand-name drugs and 79% for generic drugs. This percentage stays until you have paid off $4,750
• The Affordable Care Act aims to lower the amount you have to pay out of pocket.
• Each year from now till 2020 the percentage you pay during the gap in coverage will go down

Hospitals

• The Affordable Care Act allows the federal government to withhold Medicare payments from hospitals if too many patients return within 30 days of discharge for certain ailments such as a heart attack or pneumonia. This means there will be more focus on what happens when you leave the hospital following surgery or treatment. Instead of one quick phone call to see if you’re okay, the hospital may assign a nurse to make sure you fill your prescriptions and actually have a follow-up appointment with your regular doctor.
• There will be more emphasis on improving the quality of care in hospitals by reducing complications from infections. Poorly performing hospitals will take a financial hit if they don’t improve. Starting in 2015, federal reimbursement rates will be cut by 1 percent to hospitals that have the highest rates of infection acquired in the hospital.
• The law forces physicians to convert their handwritten patient files to electronic medical records, offering financial incentives if conversion is completed and electronic files are used in a meaningful way.
• Many exchange plans have discounts for hospitals by excluding high priced hospitals and rewarding in-network hospitals in thier programs

Doctors

• Starting in 2015, CMS will start to impose penalties to physicians who are not complying with EHR (Electronic Implementation Standard) implementation standards.
• The CMS(Centers for Medicare and Medicaid services) start imposing a penalty on physicians who do not meet E - prescribing levels.
• 2012- 1%
• 2014 - 2%
• Medicare is paying primary care physicians a 10% bonus for primary care services from 2011 through 2015
• The Affordable Care Act is encouraging physicians to engage in new technologies such as mail and texts, reimbursement systems will not reward them for face to face visits
• Doctors may get financial rewards or a larger fee from programs like Medicare if they give good quality services.

Medicaid Part D coverage gap

Most Medicare Prescription Drug Plans have a coverage gap (also called the "donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs.

In addition to the 50% discount on covered brand-name prescription drugs, the percentage you save in the coverage gap (Medicare prescription drug coverage) will increase each year through 2020.