We get a lot of questions about how the Affordable Care Act affects our Medicare population; and we wanted to take a look at how Obamacare has changed the landscape since being enacted in 2010.
1. Your Medicare coverage is protected. You do not have to enroll in the Health Insurance Marketplace or sign up for Obamacare. Original Medicare and Medicare Advantage Plans are considered credible coverage; so you are covered! One Obamacare provision eliminates the fear of not being able to get coverage due to major illness or pre-existing conditions. This leg of the law DOES NOT apply to Medicare beneficiaries wishing to purchase a Medicare Supplement Plan (Medigap) outside of an open enrollment or guaranteed issue time period.
2. Medicare recipients received new benefits as a result of the Affordable Care Act (ACA). One is more preventive services for less. Medicare now covers over 20 preventive services without charging you a deductible, copayment or coinsurance. You also get a free ‘Wellness’ visit each year by your regular doctor. For a full listing of preventive services covered, and how often they are covered, go to: https://www.medicare.gov/coverage/preventive-and-screening-services.html
3. Your doctor gets more support. The Affordable Care Act put new initiatives in place that reward hospitals and doctors for providing more coordinated care and for fewer hospital re-admissions. This creates a shift from paying for quantities of procedures and tests to rewarding the quality and value of the treatment. Many Medicare Advantage plan members are also benefitting from in-home visits from registered nurses who take vitals and help manage prescription drugs.
Medical providers also took a hit in their Medicare reimbursement rate; and so while this did help to further protect the Medicare trust fund, it does have people questioning whether medical providers will stop taking Medicare patients in the future as a result of lower payments from Medicare.
4. You will save money on prescription drugs, and will continue to do so until the coverage gap is closed in 2020 when copayments will be phased down to 25% of the total cost of the drug. In 2015, that percentage is 45% for brand names and 65% for generics. (Look for next Monday’s blog for a much more in-depth look at prescription drug costs!)
5. The ACA has also improved eligibility and drug coverage for low-income Medicare beneficiaries. By meeting certain income and asset requirements, beneficiaries may receive help paying their monthly Medicare Part B premium and pay lower copayments for medical services and prescription drugs.