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Health-care reform in 2011

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The provisions of the Patient Protection and Affordable Care Act scheduled to take effect next year include:

Insurers’ reports. Health insurers, including grandfathered plans, must annually report on the share of premium dollars spent on medical care as opposed to profits or administration and provide consumer rebates where less than 80 to 85 percent of dollars are used for benefits.

Community health centers and primary-care work force. Provides funds to build and expand existing community health centers. Also expands funding for scholarships and loan repayments for primary-care practitioners working in underserved areas.

Primary-care reimbursement. Provides a 10 percent Medicare bonus payment for primary-care physicians and general surgeons.

Health-care quality and efficiency. Establishes Center for Medicare & Medicaid Innovation to test payment and service delivery models designed to reduce costs and enhance the quality of care.

Preventive health coverage. Provides free, annual wellness visits and prevention plan services for Medicare beneficiaries and requires new plans to cover preventive services with little to no cost sharing.

Transitional care for Medicare beneficiaries. Establishes the Community Care Transitions Program to provide transition services to high-risk Medicare beneficiaries.

Medicare Advantage payment reform. Freezes 2011 Medicare Advantage payment benchmarks at 2010 levels to begin transition. Continues to reduce Medicare Advantage benchmarks in subsequent years.

Health coverage costs on Form W-2. Requires employers to disclose the value of the benefits provided for each employee’s health insurance coverage on the employee’s Form W-2.

Additional tax for withdrawals from health savings accounts. Increases from 20 to 20 percent the additional tax for HSA withdrawals before age 65 that are not used for qualified medical expenses.

Cafeteria plan changes. Creates a cafeteria plan through which small businesses can provide tax-free benefits to their employees.

Pharmaceutical manufacturers’ fee. Imposes an annual, nondeductible fee on the pharmaceutical manufacturing industry allocated according to companies’ market share.


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