Ask the Expert
Medicare and the Health Care Reform Law: What does it mean for you?
Background: Medicare offers a defined set of medical and hospital benefits to almost 50 million people age 65 and over and nonelderly people with disabilities and certain medical conditions. It consists of four parts: A, B, C, and D. Part A mainly covers inpatient services, Part B covers outpatient and physician services, Part C includes the private Medicare Advantage (MA) health plans that provide Medicare benefits, and Part D includes outpatient prescription drug coverage through private health insurers.
Most Medicare enrollees are in traditional fee-for-service Medicare, in which hospitals and doctors bill the government directly for services covered under Parts A and B. MA plans are private plans that combine Parts A and B. Also, many enrollees in traditional Medicare and MA plans purchase one of the private Part D prescription drug plans.
So here, in general terms, is what the ACA does and does not do with respect to Medicare. First, it keeps Medicare strong and solvent for those who rely on it now and for future generations. Second, it does not cut any Medicare benefits; in fact it adds benefits. Third, the government does not come between enrollees and their doctor; enrollees will continue to make health care decisions with their physician. Fourth, it does not ration health care services; in fact the law prohibits rationing of health care.
More specifically, with respect to the Medicare program, the ACA:
Adds a free annual wellness visit. Medicare will now pay the cost of an enrollee’s annual checkup.
Expands coverage of preventive services at no cost. Screenings such as mammograms are now covered free of charge.
Expands Medicare Part D prescription drug coverage. By 2020, the ACA eliminates the prescription drug “donut hole,” or coverage gap. Part D enrollees have already begun to see a phase-out of the “donut hole”; in 2011, beneficiaries paid only 50 percent of the cost of brand name drugs while in the “donut hole,” and 93 percent of the cost of generic drugs.
Eliminates cost shifting from private Medicare plans to traditional Medicare. The ACA reduces the wasteful subsidies to private plans so traditional Medicare and the trust fund no longer subsidize private insurance plans.
Provides new tools to fight fraud and abuse. The ACA cracks down on those who try to scam seniors and disabled people and steal taxpayer money.
Finally, the media and some politicians have falsely claimed that, under the ACA, $716 billion has been taken out of the Medicare trust fund to pay for the expansion of health coverage to the uninsured. The ACA did find $716 billion in spending reductions, but they impact insurance companies and hospitals, not Medicare enrollees.
For more information on how the ACA helps Medicare enrollees and the Medicare program, please visit www.medicare.gov.