Both the Patient Protection and Affordability Act and Reconciliation Act contain extensive provisions along one of the major avenues of health care services in the U.S.: the Medicare system. Several of these provisions take effect in 2010, as described below.

The Medicare Part D coverage gap "Doughnut Hole"

The Reconciliation Act provides that beginning in June of 2010, individuals who have reached the Medicare Part D initial coverage limit for 2010 will automatically receive a $250 rebate check. This provision is part of the plan to eliminate the Part D coverage gap by the year 2020. Some individuals will not be eligible for the rebate: those who receive a Retiree Drug Subsidy, those whose income exceeds Part B income thresholds, or those who receive subsidies from both Medicare and Medicaid.
The Medicare Part D "Doughnut Hole" has been a headache for many Medicare beneficiaries since the applicable part of the Medicare Modernization Act went into effect in 2006. The Doughnut Hole gap is the amount between the initial coverage limit in a Part D drug plan and the catastrophic coverage threshold. Although Part D drug plans vary, a beneficiary generally pays a deductible of $310 in addition to the monthly premium. After the deductible is met, the plan pays 75 percent of the drug costs, and the beneficiary 25 percent, until the total drug costs reach $2,830 (2010 costs). At this point, unless the plan covers the gap, the beneficiary must then pay the full cost of prescription drugs until the out-of-pocket total cost of the drugs reaches $4550 (2010 costs). From that point, the beneficiary only pays a small co-payment for generic and prescription drugs. However, paying for that gap is a struggle for those Medicare beneficiaries on limited incomes.

Environmental Health Hazard Eligibility

HHS will establish a pilot program to provide Medicare benefits to those individuals who have been subjected to environmental hazard exposure because they reside in or around an area that has been subject to an emergency declaration made as of June 17, 2009. HHS is allowed to establish optional separate pilot programs with respect to each geographic area, subject to an emergency declaration after that time.

An emergency declaration is defined as a declaration of a public health emergency under section 104(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980.

An environmental exposure-affected individual is one who has one or more conditions (including asbestosis, pleural thickening, pleural plaques, mesothelioma, malignancies of the lung, colon, rectum, larynx, stomach, esophagus, pharynx, ovary, any other diagnosis which the Department of Health and Human Services (HHS) determines is an asbestos-related medical condition, or a diagnosis of a medical condition caused by exposure of to a public health hazard in the context of an emergency declaration as HHS specifies) and has been present in the hazard area for an aggregate total of six months.

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