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PPACA: More Provisions Set to Go Live

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The new health insurance medical loss ratio rules and basic Medicare preventive services improvements are two of the Affordable Care Act provisions that will take effect Saturday.

The Affordable Care Act is the legislative package that includes the Patient Protection and Affordable Care Act (PPACA).

The new minimum medical loss ratio (MLR) rules will require health carriers to spend at least 85% of large group premiums and 80% of individual and small group premiums on health care and quality improvements.

Carriers that miss the minimum MLR targets will have to send rebates to customers starting in 2012.

The new Medicare preventive care benefits rules will fill a hole in the old basic Medicare benefits package, by providing free access to annual checkups and preventive care screenings.

Another change will provide a 50% discount for Medicare enrollees who must pay out of pocket for prescription drugs while in “the doughnut hole” – the gap between when routine drug coverage ends and catastrophic coverage starts.

Also in 2011, Medicare premiums for high-income enrollees will increase, and the U.S. Department of Health and Human Services is supposed to provide grants that small employers can use to start wellness programs.


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