Health Care Reform Changes in 2013

While many of the Patient Protection and Affordable Care Act of 2010 provisions have been implemented, there are some notable changes in 2013 that may affect you.  This year will be busy with States preparing to launch in 2014 either their own or a Federal health insurance exchange.

According to a useful Guide from Consumer Reports, here’s what to expect this year.

Standard disclosure forms. Beginning in September 2012, all health plans had to use a standardized, consumer-friendly form to provide a uniform summary of benefits and coverage, including information on co-payments, deductibles, and out-of-pocket limits. This will make it easier for you to compare plans.  Insurers will also have to calculate and disclose a patient’s typical out-of-pocket costs for two medical scenarios: having a baby and treating type 2 diabetes. See a sample form (PDF).

Caps on Flexible Spending Accounts (FSAs). Employers could still set their own limits (usually $2,500 to $5,000) on FSAs in 2012. But in 2013, the most you can set aside tax-free for medical expenses not covered by insurance will be $2,500, with the cap increasing by the annual inflation rate in subsequent years.  Plus you can no longer use FSAs to pay for over-the-counter drugs unless you have a doctor’s prescription. The cap takes effect January 1, 2013. For people with 2012-2013 health care plans that run on a fiscal (rather than calendar) year, the cap kicks in July 1, 2013. Read more about FSAs.

New Medicare tax for high earners. Two Medicare-related taxes will impact high earners in 2013. Individuals earning over $200,000 (or $250,000 for couples who file jointly) will see their Medicare payroll tax rate increase from 1.45 percent to 2.35 percent. They’ll also pay a new 3.8 percent Medicare tax on unearned income, including investments, interest, dividends, annuities, rent, royalties, certain capital gains and inactive businesses.  Read more about Medicare.

According to the Kaiser Family Foundation, other changes in this timeline include:

Phasing-in federal subsidies for brand-name prescriptions filled in the Medicare Part D coverage gap (reducing coinsurance from 100% in 2010 to 25% in 2020, in addition to the 50% manufacturer brand-name discount).

Establishing a national Medicare pilot program to develop and evaluate making bundled payments. The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care.  Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare.

For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care. It seeks to align the incentives of those delivering care, and savings are shared between providers and the Medicare program.for acute, inpatient hospital services, physician services, outpatient hospital services, and post-acute care services for an episode of care.

Increasing the threshold for the itemized deduction for unreimbursed medical expenses from 7.5% of adjusted gross income to 10% of adjusted gross income; waives the increase for individuals age 65 and older for tax years 2013 through 2016.

Increases payments to primary care doctors treating Medicaid patients and more funding for preventative services.

For a full timeline of all the changes, click here.

As always, you need to keep up with these ongoing changes.  Good sources are the  Government site and Kaiser Family Foundation.


About Elisabeth Schuler

The curator of this blog is Elisabeth Schuler, Founder and President of Patient Navigator, LLC. Her goal is to inform readers about important healthcare topics and teach them to become informed healthcare consumers.
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