While the Affordable Care Act (ACA) was signed into law in 2010, there is still confusion, particularly in the senior community with how the healthcare law impacts Medicare coverage. Finding answers about the relationship between the ACA and Medicare is a smart way to ensure you make informed decisions about your healthcare now and in the future. How does the Affordable Care Act affect seniors and will Medicare change under the new healthcare law? Here are some answers that can help.
The ACA Is Not Replacing Medicare Coverage
The new law established a Health Insurance Marketplace (online exchange) where consumers can go to purchase healthcare coverage. Many seniors are concerned that they are now obligated to purchase coverage through the Marketplace. Here are the facts: Medicare isn’t part of the Marketplace. If you are enrolled in Original Medicare or have a Medicare Advantage plan, your coverage will stay the same and you will never need to obtain your benefits through online exchanges. In fact, it is against the law for anyone to knowingly sell you a health insurance plan through the Marketplace if you are currently enrolled in Medicare.
Medicare Is “Essential Coverage” – No Additional Health Insurance Is Needed
The individual mandate as described by the ACA can be confusing. While it is true that some people who are uninsured or under insured will be required to pay a penalty, seniors on Medicare do not have to worry. Medicare is considered “essential coverage” and recipients will not be required to add healthcare coverage to an existing plan. Since most seniors are eligible for Medicare coverage at 65, as long as you are enrolled, you will not be responsible for paying a fee under the Affordable Care Act.
Preventive Care Coverage Under Medicare Has Expanded
Passage of the Affordable Care Act also means more services for seniors on Medicare, particularly preventive care. Medicare is now required to cover a host of services at no additional cost to you, including immunizations, mammograms, colonoscopies, annual wellness visits and more – all without a co-pay.
Changes to Medicare Prescription Drug Coverage
The coverage gap, also called the “donut hole” that many seniors experience with prescription drug coverage can make it challenging to afford medication. Provisions of the Affordable Care Act require Medicare to pay more, which reduces cost for seniors entering the gap. The ACA plans to eliminate the donut hole completely by 2020, but until then, seniors enjoy a 55 percent discount on covered brand name prescriptions and a 35 percent discount on generic drugs until out-of-pocket limits have been reached. While prescription drug costs have decreased for most recipients, costs have increased slightly for individuals who earn more than $85,000 and couples earning $170,000 or more.
The Affordable Care Act has made important changes to healthcare and it’s important to understand how the law impacts you and your Medicare coverage.