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2011 brings new rules in health insurance

The new year brings important changes to U.S. health-insurance rules, as new provisions related to last year's health-care overhaul take effect.

The new rules, which go into effect Saturday, include:

■ A provision that limits what health insurers can do with the money their customers send in as premiums.

The rule requires that insurers spend at least 80 percent of this money on the customers. The companies must either spend this money to pay insurance claims or use it for activities that improve customers' health.

Previously, there was no federal restriction on insurers' spending. The federal government says some insurers kept as much as 50 percent.

■ A provision that provides prescription-drug discounts for seniors who find themselves in Medicare's "doughnut hole."

The doughnut hole is a controversial gap in the Medicare prescription-drug benefit that was passed in 2006. In 2010, Medicare paid for part of the cost of drugs — until the total cost of the drugs hit $2,830. After that, seniors were responsible for 100 percent of drug costs, until they had spent $3,610 of their own money. Then, federal insurance kicked in again.

This provision will give Medicare recipients stuck in the doughnut hole a 50 percent discount on the price of brand-name prescription drugs.

■ A rule giving seniors free screenings for cancer and other diseases.

Nearly all Medicare beneficiaries will be able to receive for free all "preventive-services" screenings given an A or B rating by the U.S. Preventive Services Task Force. That could include mammograms, colorectal cancer screening, bone-mass measurement and nutritional counseling. Medicare will also provide one free "wellness visit" a year for patients who want a checkup.

■ The creation of the Center for Medicare and Medicaid Innovation. The new agency is intended to foster innovation in both caring for patients and processing their payments and claims, with a goal of keeping costs down.

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