The Affordable Care Act and Medicare

By: Taylor

With the Affordable Care Act provisions becoming effective soon, many people on Medicare will be confused as to how the Affordable Care Act will affect them and their medical coverage. To learn more about the Affordable Care Act itself, please click here.

What Won’t Change

First and foremost, it is important to stress that if you are currently on Medicare, you do not have to take part in the Health Insurance Marketplace which will open up to the public on October 1, 2013. You are already covered under Medicare and do not need to seek alternative insurance through the marketplace. That being said, those who are on Medicare, and are of a wealthy class may find that insurance through the Marketplace is less costly than they are currently paying for their Medicare benefits. For those select few, the Marketplace will be of great use to you.

Medicare recipients will be receiving notification by mail, if they haven’t already, that they need do nothing when the marketplace opens. Medicare recipients are already covered and the benefits from Medicare will essentially remain the same.

What Will Change

Preventative health care services which are categorized under the Essential Benefits Package are now completely free – no co-pay or co-insurance costs to you. Essential benefits include a wide range of services such as:

Annual Wellness Visit
Chronic Disease Management
… more
In addition to this, the coverage gap – also known as the donut hole – will completely disappear by 2020. This is great news for those who have, for years, been paying exorbitant out-of-pocket costs for prescription drugs. In the meantime, out-of pocket expenses for prescription drugs will become easier. Additional savings on covered brand-name and generic drugs if they are in the Medicare coverage gap until it disappears completely in 2020. The structured savings is designed as follows:

2012: 50% on brand name drugs and 86% on generic drugs
2013: 47.5% on brand name drugs and 79% on generic drugs
2014: 45% on brand name drugs and 72% on generic drugs
2015: 45% on brand name drugs and 65% on generic drugs
2016: 45% on brand name drugs and 58% on generic drugs
2017: 40% on brand name drugs and 51% on generic drugs
2018: 35% on brand name drugs and 44% on generic drugs
2019: 30% on brand name drugs and 37% on generic drugs
2020: 25% on both brand name and generics
Other Benefits to Medicare by the Affordable Care Act

Trust Fund Extended: The life of the Medicare Trust Fund has been extended. There will be reduction in waste, fraud and abuse, and slowing cost growth in Medicare due to provisions of Affordable Care Act. It will provide seniors with future cost savings on premiums and coinsurance.

Rehabilitation/Nursing Care: Long-term care or personal assistance is offered to people with a chronic illness or disability through this act. Personal assistance may include help with dressing, bathing, and using the bathroom.

No Reduction in Benefits: The law has prohibited insurers from reducing or taking away existing guaranteed Medicare covered benefits to seniors. You are also able to choose your own doctor.

It’s important for all Medicare recipients to review their Explanation of Benefits (EOB) notice so that they will have a clear understanding of what Medicare will provide and what your out of pocket expenses will be for the care provided.

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