Changes for Medicare Beneficiaries under the Affordable Care Act

The recent ruling to uphold the Affordable Care Act (ACA) has again raised concern and questions for some as to how the act will affect them. Most notable to Medicare recipients are the benefits already enforced such as free preventive services, free annual wellness visits and a 50% discount on covered brand-name prescription drugs for Medicare Part D recipients in the coverage gap known as the “donut hole.” In 2010 as a result of the law, seniors who had Medicare prescription drug coverage and had to pay for drugs in  the “donut hole” received a one-time, tax free rebate of $250 to help pay for prescriptions. On January 1, 2011, those that reached the coverage gap in their Medicare Part D plan received a 50% discount on covered brand-name drugs and a 7% discount on generics. Discounts will grow each year on covered brand-name and generic drugs for those who reach the coverage gap until this gap is closed in 2020. To see the full schedule of savings visit www.healthcare.gov/law/features/65-older/drug-discounts. As of January 1, 2011, numerous preventive services became covered under Original Medicare, many with no out-of-pocket costs if received from a doctor or qualified healthcare provider that accepts assignment.   Additional preventive services were added in 2012.  Some of these preventive services include tobacco use cessation counseling, cholesterol and cardiovascular screening, mammograms, medical nutrition therapy to manage diabetes or kidney disease and cervical cancer screening. Visit www.medicare.gov to see the full list of preventive services. Original Medicare beneficiaries can now receive an annual wellness visit to develop or update a personalized prevention plan based on their current health and risk factors. New Medicare beneficiaries can also now receive a “Welcome to Medicare” preventive visit, a one-time review of their health as well as education and counseling about preventive services and other care.   Those with a Medicare Advantage Plan should call their plan for more information about benefits and costs. In 2011, the ACA also began reducing the payment discrepancy between Medicare Advantage insurance companies and Original Medicare. Medicare paid on average about $1,000 more per person in Medicare Advantage than to those in Original Medicare. This led to increased premiums for all Medicare beneficiaries, including the 77% of who were not currently enrolled in a Medicare Advantage plan. The new law is now decreasing this discrepancy while guaranteeing all Medicare benefits to those enrolled in a Medicare Advantage plan and providing bonus payments to Medicare Advantage plans that provide high quality care.  ACA included the Elder Justice Act, the first comprehensive federal law to address elder abuse, neglect and exploitation, as well as provisions to address the quality of care in nursing homes.  The ACA also includes resources to improve chronic care outcomes and provides incentives to help states create alternatives to nursing home care by increasing access to home and community-based services.  To review the full list of changes under the Affordable Care Act as well as a timeline for these changes, visit www.healthcare.gov.   NCOA has posted four health reform fact sheets about the ACA and older Americans. Submitted by, Lauren Zenel CARIE Intern and MPH Candidate Drexel University School of Public Health