Health Care Reform

How Family Caregivers Will Benefit From Health Care Reform
Daughter and Mother having a discussion outdoors

When it comes to the new health reform law, what we hear about most is how it will help millions of Americans buy health insurance at more affordable rates. But there are also lots of changes in store for family caregivers. In particular, those of us in the "sandwich generation," who care for both kids and aging family members, are finally getting some long-overdue relief.

Here are the new benefits we can look forward to, in the order in which they'll become available.


Temporary Early Retiree Reimbursement Program

What it does: Makes it possible to retire early and keep your health insurance

In the past, taking early retirement meant risking your health insurance status until Medicare eligibility starts at age 65. The new law creates a temporary early retiree reinsurance program that enables employers to keep early retirees -- those between 55 and 65 -- on company health insurance plans and be reimbursed by the Federal government for up to 80 percent of the cost. Spouses and dependents are also covered.

It went into effect June 23, but payments are retroactive to the beginning of the plan year. So, if you've already incurred high health insurance costs, you and your employer can apply for reimbursement. The program is called "temporary" because it ends in 2014, when the health insurance reforms will be fully activated, making it easier for early retirees to get health insurance.

Health insurance extension for young adults

What it does: Keeps both sides of the sandwich insured

Effective immediately, young adults up to the age of 26 can stay on their parents' health insurance policies even if they're no longer full-time students. This will eliminate an enormous source of worry for family caregivers: that grown children without insurance will encounter a serious health problem, pulling the whole family into debt. The new law also forbids insurance companies from defining "preexisting conditions" in children -- so all kids, sick and healthy, can be covered more easily.

Improvements to medicare prescription drug coverage

What it does: Makes prescriptions more affordable

If you have family members hit with high drug costs due to the "doughnut hole" in Medicare prescription drug coverage, they'll get at least a bit of a reprieve with a $250 "bonus" to help cover drug costs.

No more lifetime benefit caps or policy cancellation

What it does: Prevents a family health insurance crisis due to cost

Right now, those of us caring for older adults worry about the possibility of a financial crisis if a family member should end up with high medical costs that soar beyond the "lifetime cap" imposed by our insurance -- or cause an insurer to cancel a policy. Neither of those scenarios is possible, thanks to strict new rules for health insurance companies, prohibiting them from putting lifetime benefits caps on health insurance or cancelling policies on people who use too many services.

Money follows the person

What it does: Funds transitions into community-based care

This program extends the popular Money Follows the Person demonstration grants until September 2016. These grants are made through states to help transition Medicaid-enrolled nursing home residents back into their communities, in community-based settings.

More ways that family caregivers will benefit from health care reform

January 1, 2011


What it does: Provides affordable long-term care insurance

The CLASS (Community Living Assistance Services and Supports) Act establishes a public, voluntary, long-term care program that will be affordable to many working people. If you choose to participate, there's a five-year vesting period after which, if you become disabled, you can receive a cash benefit to help pay for services and support.

Unlike many long-term care insurance plans, this program was specifically designed to support in-home care. Payments can be used for home modifications, assistive technology, transportation, home care aides, and nursing support -- including paying family caregivers. Best of all, receiving benefits from this program won't affect eligibility for other government programs.

The program is voluntary, but large employers are required to automatically register all employees; those who don't want to participate can opt out.

Relief from the "doughnut hole"

What it means: Lower prescription drug costs for Medicare patients

Currently, Medicare Part D patients with high prescription drug costs run into a coverage gap known as the "doughnut hole." This happens when their medication costs surpass the original prescription drug coverage limit; they have to pay the full cost of medications until they reach the catastrophic coverage limit. Starting in 2011, patients in the coverage gap will get a 50 percent discount on brand-name drugs, and the government will pick up 7 percent of the cost of generics. The doughnut hole will close completely by 2014.

Medicare Advantage changes

What it does: Brings Medicare Advantage costs down

The law changes the way Medicare Advantage plans are paid by bringing payments into line with the costs of the regular Medicare program. Medicare Advantage plans won't be allowed to impose higher cost-sharing requirements for certain benefits.

Community First Choice Option

What it does: Offers support for Medicaid enrollees who want home- and community-based services

This portion of the health reform legislation includes a new concept that takes direct aim at the bias in Medicaid in favor of institutional rather than home- and community-based care. Under the Community First Choice Option, states can elect to provide Medicaid beneficiaries with self-directed, home- and community-based attendant services and supports.

To encourage states to choose this option, states that do will receive an additional 6 percent in the federal government's share of Medicaid costs (referred to as the Federal Matching Assistance Percentage, or FMAP) for five years.

January 1, 2014

Health insurance mandatory for all

What it does: Decouples health insurance from employment

Starting in 2014, family caregivers will benefit enormously from the fact that health insurance no longer will be tied to employment. No more having to choose between staying employed -- and possibly paying a caregiver to look after your family member -- or leaving your job to care for your family member, and thus losing your health insurance. Starting January 1, 2014, new health coverage options and subsidies to help pay for them will allow family members to make this choice without fearing the loss of healthcare.

Subsidies for health insurance

What it does: Helps pay for insurance for low- and middle-income families

In order to help families afford mandatory insurance premiums, subsidies will be available, starting in 2014, for families making less than $88,000 per year for a family of four. The amount of the subsidies will be on a sliding scale, so people with lower incomes will receive larger benefits. In families where one adult is caring for aging family members, the household income typically goes down and medical expenses go up, so this will be doubly beneficial.

Medicare pilot program for hospital-to-home support

What it does: Provides support for transitioning from hospital to home

Buried within the health reform act is a new Medicare pilot program aimed at helping patients and caregivers successfully negotiate the transition from a hospital stay to their homes or other care settings.

Elder abuse provision

What it does: Beefs up screening of care workers

Building on a successful pilot program that ran in seven states, this little-known piece of the health reform act requires states to run background check programs for employees of long-term care facilities and providers. This new national system will give family members peace of mind by ensuring that all employees with direct access to patients have been screened.

almost 5 years ago, said...

I'm waiting to see how this all works for me. My former employer may decide to let coverage drop for us retirees to save money. Then all I will have is Medicare starting next year. I'll be unhappy to lose the extra coverage my husband and I have had but hope Medicare will be there for us. FYI, as I write this on October 22, 2011, I have recently heard that the provision for Long Term Care Insurance, CLASS, has been dropped due to the forcasted high cost. I'm afraid this is just the tip of the iceberg.

over 5 years ago, said...

I pay for my employees' insurance. All I saw from the reform was ridiculous increases in premiums. Family coverage for each employee went from $18,000 to $22,000. The agent said that was to pay for the "no cost" inclusion of 26 year olds and the removal of the $1,000,000 cap. Funny, there used to be 1, 2 and 5 million plans - now we all get 5 million plans. I don't think I can afford to pay for these plans at 100% any more. Government messes up everything.

about 6 years ago, said...

Why are some of the new programs/plans I need now after 3+ years of being a caregiver for my mom, not going to be available for years? I am 'forced ' to stay married to my wife, even though we have been separated 10 years. Yes she still supplies me with her family health plan, but in return I take care of equal monetary for her.payments or dues I mean, not actual medical expenses. How can other things be ready now. I dont get it but I do know, its bureaucracy and the lousy 2 party system. Like a Senator said recently, you do something because you believe in it and you believe its the right thing to do. Not because your party dictates a different decision and plans to use a procedural action to stop the bill. If you think its right, than you know its right and vote that way It sounds so darn simple doesn't it?

about 6 years ago, said...

I think it has no benefits. We pay into the system and still receive nothing back.

about 6 years ago, said...

What happens, if like myself, I'm 59, my husband is 69 and has Alzheimers, I am unemployed and pay my own HMO health insurance which is nearly $700 a month. I am not eligible yet for Social Security or Medicare, we are living on his Social Security and what's left of MY savings, money is not in his name. Should I get a divorce, so he'll qualify for aid(s) in New Jersey, including PAAD, $5 prescriptions.