This is the first part of three blogs (today, Sunday and Monday) on an important topic. I hope you find it helpful.
The Affordable Care Act (ACA) contains far-reaching changes that have already begun and will continue in the years to come. The purpose of this three part blog (today, Sunday and Monday) is to examine how this legislation will impact seniors, specifically those who are currently enrolled in Medicare.
Under the ACA there is an individual mandate to obtain healthcare insurance. If one fails to do so, a penalty will be imposed at $95 per adult ($47.50 per child) or 1% of the family income, whichever is greater, starting this year. The penalty rises each year and in 2016 will reach $695 per adult ($347.50 per child) or 2.5% of the family income, whichever is greater. However, for seniors, this is not as big a threat since those over 65 are eligible for Medicare coverage. As long as they enroll in the coverage available, seniors 65 and over will not face the penalty.
Although there will be payment cuts to Medicare, there are key benefits that are absolutely protected under the ACA. Medicare Part A (hospitals, hospice care and some home health services) and Medicare Part B (medical insurance) are protected and may not be cut. The changes under the ACA might result in providing seniors even more Medicare benefits.
One example of an improved benefits is the changes to what has become commonly known as the “Donut Hole.” Simply put, the Medicare law previously required recipients to reach a $310 deductible prior to Medicare kicking in to assist. At that point, enrollees starting paying 25% of the drug cost until they reached a total expenditure of $2800. The drug expense from $2800 to $4550 was then paid 100% by the enrollee. Once drug expenses reached $4550, Medicare would kick in again and the enrollee would pay only a small percentage of the prescription at that point. The Affordable Care Act has enacted a provision that requires Medicare to pick up more of the tab and will close the “donut hole” by the year 2020. Eventually, Medicare recipients will pay 25% of all prescription drugs across the board. This is good news for seniors since the number of prescription drugs taken typically increases with age.
Another benefit to seniors under the Affordable Care Act is an increase in preventive care coverage. The ACA requires that Medicare cover preventive care procedures and screenings in an effort to reduce possible necessary future treatment. Prior to the ACA, Medicare did not cover preventive services. Such services include flu shots, tobacco use cessation counseling, cancer screenings, diabetes screenings and screenings for other chronic diseases. In addition, seniors are allowed an annual wellness visit. Previously, these services, whether recommended or not, were paid out of the patient’s own pocket. No doubt the senior population sees this change as a benefit.
Part II of this series is tomorrow’s blog