Medicare Under the Affordable Care Act
Politicalrhetoric during a presidential election year and misinformation surrounds theAffordable Care Act (ACA) and has fueled fears among millions of Americans,namely those who depend on Medicare and Medicaid programs for health care andsurvival.
However,“ObamaCare,” as referred to by many Republicans and media pundits, implements anumber of positive changes for seniors 65 and older.
Medicareis the federal health care plan for senior citizens 65 or older, people under65 with certain disabilities and people of any age with End-Stage RenalDisease. It is not means tested. Medicaid is the joint state-federal programfor people with disabilities, elderly seniors, poor and low-income Americansand is means tested. Though Texas hasthe highest numbers of uninsured, Gov. Rick Perry may opt out of the Medicaidexpansion portion of the ACA. In whichcase, the federal government will by law have to pay for our state’s expanded Medicaidcoverage.
Medicare has four parts: Part A (hospital insurance),Part B (medical insurance) Part C (Medicare Advantage) and Part D (prescriptiondrug coverage). Part A helps cover hospital and skillednursing stays, hospice and home health care. Most people don’t pay a premium for this because they or a spouse paidMedicare taxes while working in the US. Though, it is available for a premium for those who don’t automatically qualify. The ACA created the Community CareTransitions Program that helps high risk Medicare beneficiaries who arehospitalized avoid unnecessary readmissions through coordinating care andlinking patients to services in their community.
Part Bcovers doctors’ and other health care providers’ services, outpatient care,medical equipment and home health care. Under the ACA, eligible seniors may seek fully covered preventative careservices, including annual wellness visits, mammograms and other cancerscreenings, diabetes and cholesterol checks, as well as flu, pneumonia andHepatitis B shots. The standard monthlyMedicare Part B premium is paid by most people, and Medigap policies are stillavailable for filling gaps in traditional Medicare coverage.
Part C,or Medicare Advantage, offers Medicare-approved plans from private insurancecompanies. Most plans cover prescriptiondrug coverage, and some may include extra benefits for an extra cost. In 2014, additional protections will beginfor Medicare Advantage plan members that will limit the amount these plansspend on administrative costs, insurance company profits and things unrelatedto health care.
It comesas a relief that existing Medicare coverage won’t be reduced or taken away, norwill the ability to choose one’s own doctor.
Changesto Medicare Part D, or prescription drug coverage, include a one-time, tax free$250 rebate to help struggling seniors (who were in the “donut hole” in 2010) payfor their prescriptions, as well as a 50 percent discount on name-brand andgeneric drugs purchased while in the “donut hole,” which the new law closes by2020.
Inorder to streamline and strengthen Medicare, the health care law tackles waste,fraud and abuse, as well as slowing cost growth. The new law makes a $350 million commitmentto prevent, root out and fight fraud in Medicare and Medicaid.