How Does the Affordable Care Act Impact Medicare?

How does the affordable care act affect medicare

A lot of Medicare beneficiaries are concerned about the Affordable Care Act (the “ACA”) or “Obamacare” and what it means for their health care coverage.

In order to help you feel better informed about the issues, we’ve compiled answers to common questions and tips to help you navigate the transition to a reformed health insurance market.

Question: Are Medicare enrollees required to do anything to comply with the ACA?

Answer: No. As a Medicare enrollee, you’re not required to do anything to comply with the health care reform law. You are not required to purchase a new health insurance product or obtain a special identification card. As someone enrolled in Medicare, your coverage requirements under the ACA are already met. You will not face a tax penalty for not having another form of insurance.

Question: Are my Medicare benefits being reduced?

Answer: No. In fact, your Medicare coverage has improved as a result of the ACA. Here’s how:

  • Free preventive care services. The ACA now provides Medicare enrollees with access to specific preventive medical services at no out-of-pocket cost. These include flu shots, smoking cessation programs, an annual wellness visit for seniors, and screenings for cancer, diabetes and several other chronic diseases.
  • Lower Medicare Part B premiums and deductibles. The Medicare Part B premium in 2012 was lower than projected due to efficiencies introduced into the system by the ACA. In the same year, the Medicare Part B deductible actually decreased – for the first time in Medicare’s history.
  • The prescription drug donut hole is going away. As a result of the ACA, Medicare beneficiaries in the Part D prescription drug coverage gap (known as the “donut hole”) now receive discounts on their brand-name and generic prescription drugs. These discounts will increase each year until the coverage gap is closed completely in 2020.

Question: Will I be eligible for government subsidies under the ACA to help pay for my Medicare premiums or medical bills?

Answer: No. As a result of the ACA, many consumers who are not eligible for Medicare will be required to purchase health insurance on their own, and some may be eligible for subsidies. However, Medicare enrollees are not eligible for ACA subsidies.

Question: Will Medicare Advantage plans go away in 2014?

Answer: No. Private Medicare Advantage plans are popular with many beneficiaries and will still be available in 2014 when the health care reform law takes full effect.

Question: Will Medigap plans still be underwritten in 2014?

Answer: The rules governing the underwriting of Medigap plans – also known as Medicare Supplement plans – have not been affected by the ACA. If you apply for a Medigap plan during your open enrollment period, you will not be underwritten (or potentially charged more based on your medical history). If you apply for Medigap coverage outside of an open enrollment period, you may still be subject to medical underwriting in 2014.

Health Reform Tips for Medicare Enrollees

  • Beware of scams. There are unprincipled people out there who may try to take advantage of confusion over the Affordable Care Act and its impact on Medicare enrollees. If someone calls and asks for personal information to make sure you’re in compliance with the law , or in order to provide you with an “Obamacare” card, hang up the phone. Contact the Federal Trade Commission at 1-877-382-4357 or the Better Business Bureau to report a suspected scam.
  • Take advantage of new medical services. As mentioned above, there are new preventive care services available to you with no out-of-pocket costs as a result of the health reform law. Feel free to take advantage of them.
  • Don’t worry. Few of the provisions of the ACA affect Medicare at all. Those that do, tend to improve coverage for seniors and other Medicare enrollees. 

Read more about how Obamacare impacts Medicare in a previous post here

Medicare has not reviewed or endorsed this information.

About Ross Blair

Ross Blair has applied more than 26 years of technology experience to develop PlanPrescriber.com, a website that makes it easier for seniors and their caregivers to select and enroll in the best Medicare products for their specific needs. In his role as CEO, he has worked closely with pharmacists, insurers, physicians, caregivers and seniors to identify the most critical and complex aspects of Medicare and create a system that delivers this information to consumers in a format that is easy to use and understand.
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