ObamaCare Medicare: ObamaCare and Medicare
Get the Facts on the Impact of ObamaCare on Medicare
ObamaCare Medicare reform improves and expands Medicare for seniors. The ObamaCare Medicare cuts are estimated at $716 billion. Those cuts are reinvested into Medicare and ObamaCare to improve care for seniors and close the Medicare Part D " donut hole" among other things. Let's take a look at what the ObamaCare's Medicare cuts and reforms really mean for seniors and how ObamaCare will impact Medicare and Medicare Advantage?
If you have Medicare Part A (Hospital Insurance) or Medicare Part C (Medicare Advantage), you’re considered covered and won't owe the fee for not having health insurance in 2014.
ObamaCare doesn't replace Medicare. Medicare isn't part of your State's health insurance marketplace (sometimes called an exchange), so if you have Medicare keep it. You will still get all the new benefits, rights and protections ObamaCare offers on your current Medicare plan. If you have retiree insurance, aren't old enough for Medicare and don't like it you may choose to use the marketplace to replace that insurance. Find out more about retiree insurance and Medigap insurance.
ObamaCare Medicare Insurance Premiums For Seniors
ObamaCare doesn't raise premiums for seniors; the AARP has predicted that it could hold the costs of Medicare Part B premiums down, if not lower them. The official formula for determining Medicare Part B premiums was established by Congress years ago and has not been negatively affected by ObamaCare.
If you have heard any talking points on how Medicare costs are negatively impacted by the Affordable Care Act you can find them debunked here and here.
ObamaCare Medicare Reform
Even though ObamaCare "cuts" Medicare; it isn't really a cut, it's health care reform aimed at improving care for seniors. The fact is, millions more seniors will be covered under Obama's health care plan. Here are some things that the program does to improve Medicare:
ObamaCare closes the "donut hole" that was causing Seniors not to be able to afford their prescriptions. (The Medicare "donut hole" is the Part D drug coverage limit where seniors must start paying out of pocket for their prescriptions.) In 2012, seniors got a 50 percent discount when buying brand name drugs and 14 percent discount on generic drugs covered by Medicare Part D. This reform gets stronger every year, increasing coverage and closing the donut hole until it disappears in 2020. From that point on, seniors will only pay usual drug co-pays.
ObamaCare expands existing coverage for seniors, including preventive care and wellness visits without charging you for the Part B co-insurance or deductible. Seniors will no longer need to put off preventive care and check-ups due to costs. This reform has been active since 2011 and gives seniors better access to cancer screenings, wellness visits, personalized prevention plans, vaccines, flue shots and more.
New initiatives to support care coordination, your doctor may get additional resources to make sure that your treatments are consistent.
ObamaCare does not cut any benefits from Medicare Advantage.
ObamaCare reduces payments to Medicare advantage rewarding those providers who increase the quality of their coverage. Medicare Advantage pays will now be more in line with other areas of Medicare
ObamaCare reigns excess spending on Medicare Advantage, which is currently causing a burden on the tax payer that is disproportionate to the amount of people it helps. Medicare Advantage is run by private insurers and costs $1,000 more per person
According to the CMS Medicare beneficiaries are expected to save, on average, about $4,200 over the next 10 years due to lower drug costs, free preventive services and reductions in the growth of health spending.
The protection of Medicare is ensured for years to come. The life of the Medicare Trust fund will be extended to at least 2029—a 12-year extension due to reductions in waste, fraud and abuse, and Medicare costs, which will provide you with future savings on your premiums and coinsurance.
The fact is, ObamaCare Medicare Reform does a lot to help seniors, as the bill addresses Medicare more than any other single issue. Many of the attacks against ObamaCare in regard to Medicare are unfounded, although the program isn't perfect one only needs to look at how seniors have benefited from the care and protections of Massachusetts health care reform under Governor Romney to understand how ObamaCare will impact Medicare.
Children under the age of 26 are able to be covered under their parents insurance. The caveat, however, is that if your parents are over 65 and therefore receive Medicare you are no longer eligible to be covered under their insurance. While this may "make sense" it comes as a low blow to those who took the law at face value.
Does Medicare Meet ObamaCare’s requirement that all Americans have health insurance?
If you have Medicare Part A (Hospital Insurance) or Medicare Part C (Medicare Advantage, you’re considered covered and won’t need a Marketplace plan. Having Medicare Part B (Medical Insurance) alone doesn’t meet this requirement.
Can I get a Marketplace Plan in Addition to Medicare?
No. It’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan. This is true even if you have only Part A or only Part B.
If you want coverage designed to supplement Medicare, visit Medicare.gov to learn more about Medigap policies. You can also visit Medicare.gov to learn more about other Medicare options, like Medicare Advantage Plans.
Accountable Care Organizations and Other Little Talked About Medicare Related Provisions in the Affordable Care Act
There are hundreds of little talked about provisions in the Affordable Care Act that are very effective but rarely talked about, and many of them pertain to improving Medicare. For example, Section 3022 of the PPACA includes guidelines for the establishment of accountable care organizations (ACOs) under the Medicare Shared Savings Program.
ACOs are groups of are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, shares in the savings it achieves for the Medicare program.
Know the Law. The Affordable Care Act contains 10 titles, each title addresses a different aspect of health care reform. Title III - Title III Improving the quality and efficiency of health care addresses most of the changes to Medicare. Check out our Summary of Provisions of the Patient Protection and Affordable Care Act for a plain English summary of each provision pertaining to the Affordable Care Act and Medicare.
Medicare and the Donut Hole
Most Medicare Prescription Drug Plans have a coverage gap (also called the "donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs. Seniors in the Medicare Part D “donut hole” can now get a 50% discount when buying Part D-covered brand-name prescription drugs and a 14% discount on generic drugs covered by Part D. The discount is applied automatically at the counter of the pharmacy—so seniors don’t have to do anything to get the discount. By 2020, the donut hole will be eliminated completely. Read more about the Medicare Part D Coverage Gap (Donut Hole).
Medicare and the Health Insurance Marketplace
Medicare isn't part of ObamaCare's Health Insurance Marketplace, no one has to replace their Medicare coverage with Marketplace based health insurance. No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you'll still have the same benefits and security you have now. You won't have to make any changes.
Confused about Medicare? Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
How to Sign Up for Medicare
You can sign up for Medicare online in under 10 minutes.
Click here to sign up for Medicare.
Click here to sign up for Medicare Advantage.
NOTE: Remember you won't use the Health Insurance Marketplace to sign up for Medicare.
Changes to Medicare Insurance in 2013 - 2014
Not much changes for Seniors in 2013 - 2014. Find out how the Affordable Care Act affects your Medicare Insurance and what if anything will change for you as the Health Insurance Marketplaces are implemented. Changes to Medicare Insurance 2013 - 2014
ObamaCare Medicare Myths
Medicare is ending. False. ObamaCare is not replacing Medicare. In fact many of the provisions contained within the new law strengthen Medicare, improve it's quality, help lower costs and ensure Medicare for years to come.
Seniors on Medicare must buy more health insurance to comply with the ACA. False. Medicare (and all Medicare related insurance plans such as Medigap and Medicare advantage) count as minimum essential coverage, which means you are exempt from the mandate to buy insurance. Medicaid, CHIP, TRICARE and other government programs all count has "having health insurance".
Medicare beneficiaries will pay more for their medications under ObamaCare. Partially true. Under the ACA, higher-income Medicare beneficiaries – those who earn more than $85,000 per person or $170,000 per couple – pay slightly more for their prescription drug coverage, or Medicare Part D. But this only affects about 5 percent of beneficiaries
Medicare beneficiaries won't be able to see their current doctors. False. Nothing in the ACA changes which doctors Medicare patients can see.
Medicare premiums are rising. Partially true. Medicare premiums are calculated by the Medicare part B formula. This has nothing to do with ObamaCare, premiums do rise historically, but not due to the new health care law.
ObamaCare and Medicare Costs for High-Income Seniors
The formula for Medicare part B is unaffected by ObamaCare and most seniors won't see a rise in the prices they pay. However Medicare recipients with higher incomes have historically paid more for their Part B coverage, which is the "medical insurance" portion of the program and helps pay for outpatient medical care such as doctor visits, lab tests and durable medical equipment. High-income seniors may still continue to pay higher rates despite the changes to Medicare.
ObamaCare Medicare Tax Increase
ObamaCare implements an Medicare tax part A increase of .9% for businesses making over $250,000 in profit and employees earning over $200,000 to help pay for the improvements to Medicare. So while seniors will save money by closing the donut hole and overall reforms, some people will pay more to help support ObamaCare Medicare reform.
ObamaCare Medicare: Value-based Payment Rewards Hospitals for Providing Quality Care
ObamaCare's Medicare reform enacts a Value-Based Payment Provision. The Medicare provision states Hospitals can gain or lose 1% of Medicare funding or gain a 1% increase depending on 20 factors that gauge quality vs. quantity care.
Specifically, the factors include quality measures related to treatment of patients with heart attacks, heart failures, pneumonia and certain surgical issues, as well as patient satisfaction.
In other words, if a hospital has a high re-admittance rate or poor treatment they can lose a percentage of funding whereas if they have a low re-admittance rate they can gain funding.
Some hospitals have already been hurt, while some have gained significant funding. Although the drawbacks are obvious in the short term, it has created an incentive to improve the quality of care in hospitals.
ObamaCare Medicare penalties / rewards will rise over the next two years to a total of 2%.
During the last half of 2012, CMS reports that hospital readmissions dropped by 70,000 for the first time on record.
Update December 1st, 2013: ObamaCare's Medicare reforms are already increasing the quality of care and decreasing costs. Administration officials have pointed to falling hospital readmission rates as one strong sign that cost-control provisions in the Affordable Care Act are working. Also, they noted that a growing number of insurers and health care providers are agreeing to contracts that pay for the quality of care, rather than the quantity, another indication that the law’s encouragement on that front is starting to pay dividends.
Independent Payment Advisory Board (IPAB)
ObamaCare creates a 15 member board called the Independent Payment Advisory Board (IPAB). The IPAB is appointed by the President, and confirmed by the Senate to serve six-year terms. The purpose of the board is to oversee Medicare costs and to lower the per capita growth rate of Medicare spending.
ObamaCare has recovered tens of billions of dollars from fraudulent Medicare and Medicare Advantage payments since the bill was signed into law in 2010.
What is Medicare?
Medicare is a Government run program that we all pay into via our taxes. Medicare is offered to seniors when they reach 65, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Medicare provides comprehensive care including:
Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (Medical Insurance)
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Medicare Part D (prescription drug coverage)
Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
Medicare recipients will have access to all of ObamaCare's new benefits, rights and protections and get some that are Medicare specific too.
What is Medicare Advantage?
Medicare Advantage is a private coverage option which has driven profits of private health insurance companies up, yet puts a larger burden on the government to fund Medicare. While some seniors may personally benefit from a Medicare Advantage plan, they have created some cost issues.
Medicare Advantage provides:
Medicare Part C (Medicare Advantage Plans)
A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
ObamaCare Medicare cuts aim to fixes some of the aspects of Medicare Advantage that weren't working.
The following article from Huffington post, written by a writer who has had both Medicare and Medicare Advantage, discusses the changes to Medicare and Medicare Advantage under the Affordable Care Act.
Medicare Open Enrollment
For most people, the initial enrollment period for Medicare Part A and Part B starts 3 months before their 65th birthday and ends 3 months after their 65th birthday. After initial open enrollment there are two open enrollments each year where you can switch your plan or add to it. The first general enrollment period goes from January to March with coverage starting July 1st.
Individuals who have Medicare Part A and Part B may enroll in a Medicare Advantage plan during the Annual Election Period (AEP), the second enrollment period, which lasts from October 15 through December 7. Individuals who were eligible for Medicare Part A or enrolled in Part B as of the effective date of coverage can enroll in a Part D plan or switch Part D plans during this time. Individuals can also enroll in a Part D plan if they had qualified for a Special Election Period (SEP).
In addition, beneficiaries have from January 1 through February 14 to disenroll from their plan and return to traditional Medicare. A Medicare Advantage enrollee, however, cannot switch from his or her existing Medicare Advantage plan to a different plan during this period.
Learn more about Medicare and the Affordable Care Act.
ObamaCare Medicare Cuts, Changes in Medicare Spending
Over the next ten years, ObamaCare will cut Medicare by $716 billion and spend nearly that much trying to reform it. In fact all money cut from Medicare must be used to increase Medicare solvency, improve its services, or reduce premiums. Medicare currently affects over six hundred thousand physicians who care for nearly 100 times as many senior citizens who are provided for under Medicare and Medicare Advantage.
The concept behind the ObamaCare Medicare cuts is simple, cut out the parts of Medicare and Medicare Advantage that aren't working and use that money to fix the parts that need reform. The end result should improve the system and result in curbed spending and a more effective program.
Although there can be a lot of debate about the Medicare cuts, the end results for seniors is good. Millions of seniors are getting free preventive treatments, wellness visits, rebates for out-of-pocket costs on drugs and are saving money due to ObamaCare starting to close the "donut hole."
ObamaCare cuts Medicare and Medicare Advantage $716 Billion 2013-2022. $415 Billion comes from cutting tax payer money that is going to doctors, hospitals and private insurance companies... Most health care officials, workers and hospitals agree that ObamaCare helps the health care industry and specifically Medicare and Medicaid.
The ObamaCare Medicare cuts will mainly affect hospital reimbursement rates for hospitals and private health insurance companies. The claim is that by cutting the profit hospitals and insurance companies make off of Medicare and Medicare advantage, the less help seniors will be able to get. This, however, is nothing more than a "Medi-scare."
ObamaCare Medicare Advantage Reform
When Medicare Advantage came onto the scene, it was supposed to drive the costs placed on the government to provide "free" healthcare to seniors via Medicare down. This would ultimately save the tax payers' money as private insurance companies would bid for contracts.
This isn't what happened, however. It actually increased the amount we the tax payers had to pay by driving costs up! So, of course the private insurance companies don't like the idea of being regulated. That means less "free" money from the government for them... This stands in a stark contrast to the "no government"-plea from the same side of the aisle who is propagating the "Medi-scare."
ObamaCare also seeks to decrease the amount paid to hospitals for Medicare. However, hospitals have already agreed to this, since they know once everyone has insurance under the Affordable Care Act they will see a large influx in the amount of visitors to their hospitals. Therefore, they will at least break even, if not profit, while saving the tax payers money. Thus reforming the healthcare system.
ObamaCare now requires that Advantage plans cannot charge enrollees more than traditional Medicare for chemotherapy administration, skilled nursing home care and other specialized services. Starting in 2014, Medicare Advantage plans cannot spend more than 15 % of their Medicare payment on administrative costs, insurance company profits and non-healthcare related items. These cost cutting measures are estimated to bring in $1,000 in savings to CMS per Advantage Plan member without reducing any benefits. This is expected to help decrease Medicare part B payments, especially for low income seniors. Remember: Medicare Advantage Plans must provide at a minimum what Original Medicare covers.
Where Do the Rest of the Medicare and Medicare Advantage Cuts Come From
It's no secret that the current Medicare system isn't working, it's bankrupting itself and causing an increasing burden on the tax payer. The rest of the cuts to Medicare include things like Medicare Disproportionate Share Payments (which hikes up rates for others by ensuring care to uninsured patients), lower payments to home health providers and other cuts that do not affect seniors care but essentially make the system run smarter.
This isn't to say that ObamaCare lays out the perfect plan for Medicare; it only is saying that the drastic number of $716 billion is meant to save Medicare, fix what is wrong with it and ensure that it remains sustainable while providing quality, affordable healthcare to seniors.
So does ObamaCare Medicare reform cut Medicare and Medicare Advantage? Yes, But the Medicare cuts are a good thing. Millions of seniors will benefit from the ObamaCare Medicare reforms. Make sure to let the seniors in your life know that ObamaCare helps Medicare and seniors.