For nearly half a century, Americans aged 65 and older have relied on Medicare benefits to help with their medical costs. Since those in their golden years experience declining income coupled with rising healthcare costs, it’s understandable that many are concerned with how the Affordable Care Act (ACA) affects their Medicare coverage. Fear not – because the ACA actually expands benefits, gets rid of many non-essential costs, reduces fraud, and assures quality care to all. Here are some of the advantages experienced by Medicare beneficiaries since the ACA went into effect four years ago:
Free Preventative Services Added
Under the ACA, many preventive benefits have been added to those with Medicare—with no copay. Benefits include annual wellness visits, cholesterol checks, flu shots, mammograms, cancer screenings, and colonoscopies. In 2013 alone, more than 37 million seniors received at least one of these preventive services with no out-of-pocket costs.
Prescription Coverage Gets Better
By 2020, the ACA will banish the existing donut hole—that coverage gap where beneficiaries pay 100 percent of the cost of prescriptions. Until then, Medicare users will receive graduated discounts for brand-name (Part D-covered) and generic drugs. In 2013, for example, a beneficiary in the donut hole received a 52.5 percent discount on brand-name drugs and 21 percent off generics. The discount is automatically applied at your pharmacy, so you don’t have to fill out additional paperwork.
Part B Premiums Lowered
Through ACA reforms, Medicare has become more efficient at reducing health costs, which help keep Part B premiums from rising. The Congressional Budget Office estimates that Medicare and Medicaid funding will be reduced by 15 percent or $200 billion by 2020. This year, the Medicare Part B monthly premium is $104.90 (lower than Medicare trustees previously projected) while the Part B annual deductible is $147 (the same as in 2013).
Fraud and Abuse Decreases
The ACA has ramped up government efforts to thwart fraud and abuse; and has also imparted tougher penalties on those receiving fraudulent payments. According to the Centers for Medicare and Medicaid Services, the crackdown on Medicare fraud and abuse brought on by the ACA will save an estimated $7.8 billion through 2016. Since 2010, the government has recovered more than $14.9 billion from these swindlers.
Care Coordination Improves
The ACA provides support for physicians to coordinate patient care services. This includes enhanced hospital discharge planning. When you leave the hospital, follow-up care will be coordinated with your primary care physician and other specialists. These efforts will help prevent people from being re-admitted unnecessarily to the hospital.
Advantage Plan Premiums Decline
Since the ACA went into effect, average private Medicare Advantage (MA) plan premiums have declined by nearly 10 percent, while enrollment has increased by 33 percent. The ACA limits the amount these plans spend on administrative costs; and also caps insurance company profits and administrative expenses to 15 percent of Medicare premiums. Additionally, MA plans cannot charge participants more than traditional Medicare for chemotherapy administration, skilled nursing home care, and other specialized services.
Help Available to You
Medical expenses can be a worry for all of us. Securing a reverse mortgage helps qualifying seniors to pay for medical costs not covered by Medicare. If you have family and friends who don’t have health insurance, or if they want to explore new health plan options, have them visit healthcare.gov. Detailed Medicare coverage and choices can be found at medicare.gov.