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Health Care Reform and What It Means for Seniors

Sarah Stevenson
By Sarah StevensonOctober 27, 2013

When it comes to the Affordable Care Act, what do seniors need to know? Learn the basics about what these changes will mean for your family.

Health Care Reform and Seniors

There’s a lot of information flying around about the Affordable Care Act—also called Obamacare—and what the new health care law is going to mean for everyday Americans. We’ve collected the most important facts about how the law affects seniors and what caregivers need to know about this latest transition in the health care system, particularly if your older loved one is covered by Medicare.

The Affordable Care Act and Medicare

If your parent is over the age of 65, then chances are pretty good he or she is a part of the Medicare or Medicare Advantage program. The number one take-away we want our readers to know is that if you already have Medicare or Medicare Advantage, you do not have to worry about shopping for senior care coverage in the new insurance marketplace. If you have Medicare, you’re considered covered according to the new legislation. Of course, you will still have the opportunity to modify your Medicare coverage during the open enrollment period, October 15th through December 7th.

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How Does Health Care Reform Affect Medicare Coverage?

Just because Medicare recipients don’t need to shop for new coverage doesn’t mean the new law doesn’t affect you. Fortunately, the news is good: Health care reform strengthens Medicare coverage in a number of ways, despite some of the dire predictions. Here are a few key points, as distilled by the AARP and the Department of Health and Human Services:

  • Firstly, your guaranteed Medicare benefits are yours—what you earned during your career is protected, and that care will be there when you need it.
  • The law makes a 10-year commitment to fighting fraud, waste, and abuse in Medicare and Medicaid, a move which is expected to provide cost savings on your premiums and co-insurance in the future, as well as extending the life of the Medicare Trust Fund.
  • Incentives are provided for higher quality of care and better coordination of care among doctors and hospitals. Medicare Advantage plans will also have incentives for higher quality of care.
  • This also means hospitals are reimbursed differently: instead of just being paid by the overall number of procedures, a portion of payment will depend on the quality and value of the services they provide. This is expected to reduce preventable re-admissions to the hospital for the same condition.

Health Care Reform’s Biggest Perks for Seniors

Besides the general changes to the way Medicare works, there are a few major perks that Medicare recipients will receive as a result of the Affordable Care Act:

  • Closing the donut hole and lowering prescription drug costs. The AARP puts it clearly and simply: “If you have prescription drug coverage under Medicare Part D and fall into the coverage gap, or doughnut hole, your out-of-pocket drug costs will be greatly reduced in the future. You’ll get discounts on brand-name and generic prescription drugs while you are in the doughnut hole. These discounts will continue to increase until 2020, when the doughnut hole will disappear.” If you have Part D, you’ll still need to pay your premiums and co-payments, but your prescriptions will be more affordable. For more details on what you’ll pay for prescriptions, visit the Health and Human Services page on Medicare Drug Discounts.
  • More information and protection for nursing home care. In addition to requiring states to provide comprehensive information on nursing homes, including inspection reports and complaints, it will be easier to file a complaint, and the process must ensure that there is no retaliation against the consumer (AARP).
  • Access to free preventive care. Medicare now covers many more preventive services as long as they are administered by a qualified provider. New Medicare recipients will receive a fully covered “Welcome to Medicare” preventive visit under Medicare Part B. Those who have been covered for longer than 12 months can get a customized yearly wellness visit. (Note: This is not the same as a physical—a physical exam is more extensive and generally is not covered except under certain Medicare Advantage plans.) Other preventive services that qualify for coverage include diabetes screening, colonoscopy, mammograms, cervical cancer screening, cholesterol screening, and flu shots. View the full list on Medicare.gov.

Have you experienced any changes in your Medicare experience, either positive or negative, since the implementation of health care reform? We invite you to share your stories in the comments.

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Sarah Stevenson
Sarah Stevenson
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