Medicare and the Affordable Care Act: What’s Next?

vpasheader0311There are many important changes under the Patient Protection and Affordable Care Act of 2010 (ACA) that improve access and services for people with Medicare.  There are also many myths about how the ACA will affect Medicare benefits.

Medicare beneficiaries have already seen many improved benefits under the ACA. Already in place are a long list of preventive screenings and tests that are completely free of charge to the patient. Medicare Advantage plans may no longer refuse to enroll individuals because of their medical history (except for those suffering from end-stage renal disease). Prescription drug plans are subject to increased oversight regarding their marketing and payment practices.

Still to come are many additional improvements to benefits. Each year the coverage gap or “donut hole” in prescription drug plans is shrinking. This temporary loss of coverage for those who use many medications or expensive drugs will be gone completely by 2020.

While annual payment increases to hospitals, long-term care facilities and home health agencies will slow to encourage efficiency and keep Medicare solvent longer, payments will not decrease to Medicare providers. Payments for primary care services will actually get larger.

The law establishes an independent advisory board to slow Medicare spending over time. This board, however, cannot change Medicare eligibility rules or reduce Medicare benefits. Those changes can only be made by the Congress.

The ACA includes funding that will benefit rural areas such as ours. Incentives to hospitals and other providers to increase access to services, funding for community health centers, and test programs to make it easier to get specialty care are among the provisions of the law.

It is important to note that the Federal government, including the Centers for Medicare and Medicaid, have only partial control over Medicare Supplement, also known as Medigap, insurance policies. They can and do require that the basic benefits of policies in the 10 available plans are consistent from company to company and from state to state. However, each state has its own rules about premium amounts and increases. In Virginia, the Bureau of Insurance must approve requested rate hikes, based on a variety of data submitted by each company licensed to do business in our state.

In all, the ACA has provided better access to more affordable care to Medicare beneficiaries earlier than to the rest of the population. While younger individuals and families will see more significant changes in the next several months and years, the changes for those on Medicare have been more gradual, have come sooner, and have generally meant less expensive, more accessible medical care.

Maury River Senior Center has state-certified Medicare Insurance Counselors who are available to answer questions about Medicare, provide information to help individuals make informed insurance choices, and help investigate problems with Medicare, drug plan, and Medigap coverage and billing issues. To make an appointment with a counselor, call MRSC at 261-7474.

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