What Medicare Insurance Means for Seniors Under the Affordable Care Act (ObamaCare)
Changes to Medicare insurance under ObamaCare: For Seniors with Medicare insurance or Medicare Advantage not much will change under the Affordable Care Act (ObamaCare). Most seniors will enjoy the benefits, rights, and protections of the new health care law like expanded access to wellness visits, more preventative care, and cheaper drugs with little or no change to their insurance costs.
Although most seniors will have nothing to worry about, some higher-earning seniors may see their Medicare or Medicare Advantage premiums rise or be affected by some taxes like the capital gains tax.
The money to improve Medicare and extend it’s solvency 2029 doesn’t come out of the pockets of Medicare recipients. It comes from ObamaCare’s focus on cutting Medicare fraud, waste, and abuse, and it’s many Medicare-focused cost-curbing measures.
Let’s find out what the ACA means for Seniors and Medicare.
No one who qualifies for Medicare has to pay a fee for not obtaining insurance or shop on their State’s Health Insurance Marketplace. If you like your Medicare insurance, you can keep it.
Seniors Medicare Insurance: What You Need to Know
During the presidential election, The Affordable Care Act (ObamaCare) and Medicare were blended. Now with the State exchanges (sometimes known as marketplaces) open for business, it is time to set the record straight for Medicare insured Americans.
If you already have insurance through traditional Medicare or Medicare Advantage, the ACA, ObamaCare, does not affect you. You need to do – NOTHING.
Seniors will be able to get all of the benefits of the Affordable Care Act, but won’t be responsible for most of the costs.
Below we take a look at the changes in Medicare benefits and Medicare Costs, but first, several pieces of misinformation need clarification.
Clearing Up the Medicare Myths
There are lots of myths out there about Seniors and their Medicare health insurance. Let’s debunk some of the common myths about Medicare based Health Insurance and the Affordable Care Act:
ObamaCare Means Medicare is Over
ObamaCare replacing Medicare is a myth. ObamaCare does not replace Medicare or Medicare Advantage, although it does reform some of the wasteful spending and other issues that were negatively affecting seniors. Everyone on Medicare or soon to be on Medicare, or scheduled to be on Medicare a decade from now will get Medicare.
In fact, certain features of the ACA protect Medicare benefits in new ways according to Nicole Duritz, AARP’s vice president for Health Education and Outreach.
To Comply With ACA, Seniors Must Buy More Health Insurance
Seniors with Medicare do not have to purchase any other type of health insurance. Medicare is a recognized health insurance under the Affordable Care Act. If you have Medicare, then you are in compliance. This groundless story came about from the Mandate. However, the time that the Exchanges open overlaps with Medicare open enrollment. Medicare policy owners may switch from traditional Medicare-to-Medicare Advantage and have the right to change their prescription coverage plans. However, the Exchanges do not deal with any Medicare changes. And there is no requirement for Medicare insured to make any changes.
Medicare Will Cost More
It is a half-truth that Medicare costs will rise due to legislation. Premiums will rise, as they did have historically. This particularly affects individuals who earn more than $85,000 or couples with incomes over $170,000 according to existing law. The ACA, ObamaCare, has nothing to do with it. Part B premiums for the more affluent will continue to be higher than for other income groups.
Changes in Medicare Benefits
There are a few important changes to Medicare that affect Medicare benefits directly, let’s cover those. You can see a full breakdown of the effects of ObamaCare on Medicare here.
More Preventive Services
Starting in 2014, Preventive Services were extended. Seniors now get certain preventive services like mammograms or colonoscopies, without charging you for the Part B coinsurance or deductible.
- Abdominal aortic aneurysm screening
- Alcohol misuse screenings & counseling
- Bone mass measurements (bone density)
- Cardiovascular disease screenings
- Cardiovascular disease (behavioral therapy)
- Cervical & vaginal cancer screening
- Colorectal cancer screenings
- Depression screenings
- Diabetes screenings
- Diabetes self-management training
- Glaucoma tests
- Hepatitis C screening test
- HIV screening
- Mammograms (screening)
- Nutrition therapy services
- Obesity screenings & counseling
- One-time “Welcome to Medicare” preventive visit
- Prostate cancer screenings
- Sexually transmitted infections screening & counseling
- Tobacco use cessation counseling
- Yearly “Wellness” visit
More Wellness Visits
As of 2014, seniors were entitled to an additional annual wellness visit. This “Wellness” visit isn’t like the traditional wellness visit; it’s a chance for seniors to talk to the doctor about chronic conditions like diabetes or depression and to develop a plan to lessen the damage done by the disease.
The Donut Hole: Closing the Part D Gap to Save on Prescription Drugs
The Affordable Care Act, ObamaCare, began to close the Part D donut hole that was making drugs unaffordable for seniors in 2013. The gap isn’t scheduled to be completely closed until 2020. However, each year the ACA works toward making Medicare drug costs more affordable.
Prescription benefits improve: You can save money on brand-name drugs if you’re in the “donut hole,” you’ll also get a 50% discount when buying Part D-covered brand-name prescription drugs. The discount is applied automatically at the counter of your pharmacy—you don’t have to do anything to get it. By 2020, you’ll pay only 25% for covered brand-name and generic drugs during the gap—the same percentage you pay from the time you meet the deductible (if your plan has one) until you reach the out-of-pocket spending limit (up to $4,750 in 2013).
|Year||You’ll pay this percentage for brand-name drugs in the coverage gap||You’ll pay this percentage for generic drugs in the coverage gap|
Medicare Part B Formula
The Medicare Part B Formula isn’t affected by the Affordable Care Act. Find out how the Medicare Part B formula works to help figure out if you will have to pay higher rates. Remember ObamaCare doesn’t affect premium rates for Seniors.
Here a Basic Overview Costs for Medicare in 2013 for seniors making less than $85,000 as an individual or $170,000 as a couple. Even though ObamaCare had been in place for three years at the time these figures were gathered, not much changed. The opening of the health insurance exchanges don’t have an impact on Medicare insurance costs.
|2013 Costs at a Glance|
|Part B premium||Most people pay $104.90 each month.|
|Part B deductible||$147 per year|
|Part A premium||Most people don’t pay a monthly premium for Part A. If you buy Part A, you’ll pay up to $441 each month.|
|Part A hospital inpatient deductible|| You pay:
Premiums Lowered for Most
However, in 2012 most Part B Medicare policyholders saw a reduction in Part B premiums due to reforms under the ACA. In addition, the deductible went down for the first time in Medicare’s history.
Under the New Law Senior Must Pay the Penalty
More lies. People insured by Medicare are in complete compliance with the Affordable Care Act. They are not subject to the penalty for failure to buy insurance. In fact, folks enrolled in Medicare cannot purchase insurance through the exchanges. A company selling a policy to Medicare recipients is a violation of the law.
Medigap and Medicare Advantage Supplemental Plans
Beyond traditional Medicare Parts A and B, seniors have other Medicare insurance options to help better meet their true medical costs. Supplement plans include “Medigap” which “covers the gap” between what Medicare pays and what your actual medical expenses may be and supplements traditional Medicare Parts A and B. Since you’ll have traditional Medicare, even with added in Medigap options, you’ll still be covered under ObamaCare.
Medicare Advantage, while not technically a type of supplemental health insurance, comprises a variety of plans that Medicare offers as a coverage alternatives to the traditional program. Medicare Advantage can be described as supplementing Medicare.
Please note you cannot have both Medigap insurance and Medicare Advantage. Both Medigap and Advantage options are sold by private companies.
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 and beyond.
Medicare Enrollees Get New Free Benefits Under ACA
Under the Affordable Care Act, folks on Medicare are entitled to free preventative care that includes flu shots, cancer, and diabetic screening, and an annual wellness exam. Your primary caregiver will give you the information.
The Affordable Care Act is not replacing Medicare. ObamaCare or the Affordable Care Act expands services to folks on Medicare, free and helps those who could not afford medical insurance before the law goes into effect. Medicare recipients do not have to buy anything from a state exchange – in fact, the ACA prohibits them from doing so. If you have Medicare, you have insurance and meet the mandate. There are no fines for not meeting the mandate for your group. You already meet the mandate. Where Medicare and ACA come together, Medicare patients gain.
Under ObamaCare, Medicare provides more services and is financially better off. Seniors should welcome the changes and embrace them.
ObamaCare Changes to Medicare