Day five of a five-day series
FRIDAY, Sept. 27 (HealthDay News) -- The Affordable Care Act
will help millions of uninsured Americans get health coverage. But
is it good for people on Medicare?
It depends on whom you ask.
Two-and-a-half years after the law was passed, pundits remain
divided over its impact on older adults and the overall fiscal
health of Medicare, the government-run health insurance program
that currently serves roughly 50 million Americans.
Amid the rhetoric, many seniors fail to grasp how the
health-reform law affects them.
"The reality is that there's a lot of confusion about what it
does and how it does it," said Andrea Callow, policy attorney in
the Center for Medicare Advocacy's Washington, D.C., office.
For adults on Medicare, the most beneficial elements of health
reform are already taking effect, advocates say.
Joe Baker, president of the Medicare Rights Center, in New York
City, which helps people on Medicare and their caregivers
understand their options, counts the closing of the "donut hole" in
Medicare's prescription drug benefit and the addition of free
preventive care among the most beneficial parts of the law.
"These two things have really modernized the Medicare program
and really provided better coverage and more comprehensive coverage
for people with Medicare," he said.
Before health reform, seniors paid 100 percent of their drug
costs while they were in the so-called donut hole, a temporary but
extremely unpopular gap in Part D, Medicare's prescription drug
The gap is a problem for seniors who have very high drug
expenses. In 2014, seniors will pay $3,605 in donut hole expenses
before their Part D coverage resumes.
The Affordable Care Act slowly erases the gap so that, by 2020,
beneficiaries' share of the cost of covered drugs will drop to 25
percent -- the same as a typical copay in a standard health plan.
At the same time, drugmakers and the federal government are picking
up an increasing share of the cost.
"It's making a big difference for a swath of beneficiaries who
get into the donut hole and have had some problems affording their
drugs," Baker said.
At last count, more than 6.6 million Medicare beneficiaries have
saved more than $7 billion on prescription drugs since the
enactment of the Affordable Care Act in 2010, the U.S. Centers for
Medicare and Medicaid Services reported in July.
But Robert Moffit, a senior fellow at The Heritage Foundation, a
prominent conservative think tank in Washington, D.C., said
enriching the drug benefit will ultimately increase premium costs
"There's no such thing, even in Medicare, as something for
nothing," Moffit said.
So far, however, premiums have remained fairly stable, federal
health officials report. The average Part D premium for a basic
plan is projected to rise to $31 in 2014, up from $30 the past
three years, according to data released in July.
Free screenings, wellness visits
Seniors are also getting new preventive health benefits as a
result of the health-reform law. As of 2011, most preventive
services -- including mammograms, prostate cancer screenings,
colorectal cancer screenings and vaccinations -- are now free of
Medicare patients are also entitled to a free annual "wellness
visit" -- a chance to work with their doctors on developing a
personalized plan for staying healthy and preventing disease. The
free visit, which has been available since 2011, does not include
any treatment or follow-up care that your doctor may provide.
Use of preventive services such as screenings and wellness
visits has increased among people with Medicare coverage, the U.S.
Centers for Medicare and Medicaid Services reports. In 2012, an
estimated 34.1 million people benefited from Medicare coverage of
preventive care with no cost-sharing. And in the first six months
of 2013, 16.5 million people with traditional Medicare took
advantage of at least one free preventive service.
Even though seniors are seeing lower costs at the pharmacy and
saving on preventive health services, they may not know it because
"they're not tying it in with the ACA (Affordable Care Act),"
attorney Callow said.
Health reform doesn't just tweak existing benefits. It's also a
potential source for innovations that may yield better patient
care, advocates say.
One model that's under scrutiny -- the so-called accountable
care organization -- brings together hospitals, doctors and other
health-care providers as a team. The "ACO" takes responsibility for
coordinating care; preventing medical errors; reducing unnecessary
services, such as hospital readmissions; and, hopefully, slowing
Some see innovations, cost savings; others see potential
Few Medicare patients know about accountable care organizations
or whether they're even in one, said the Medicare Rights Center's
Baker. The center encourages people to read letters they receive
from their doctors describing the concept and to take advantage of
benefits that might be offered to them.
"We'll see how it plays out over the longer term, but certainly
the promise of accountable care organizations is that they'll be
providers in the driver's seat better managing and coordinating
care, particularly for those with chronic or multiple health
issues," he said.
But some "Obamacare" critics see the Affordable Care Act as a
train wreck in the making.
Some of the worst provisions don't affect seniors directly but
could harm access to health care services, they say. For example,
the law slows payment increases to Medicare providers, including
hospitals, nursing homes, home health agencies and hospices. It
also creates an Independent Payment Advisory Board to identify ways
to slow growth in Medicare spending should per-person spending
exceed a specified target.
As health reform plays out, seniors may want to take matters
into their own hands. With open enrollment beginning on Oct. 15,
it's a good time for Medicare beneficiaries to take a closer look
at what they're getting for the money and whether it makes sense to
change health plans or drug coverage.
"We're hoping with all the press surrounding the ACA and all of
the noise about health insurance that seniors will be encouraged to
take a look at their Medicare coverage," Callow said.
AARP has more on
how health reform affects Medicare.
To read part one of the series, how to navigate the new health
To read a part-one story on the potential impact on young
To read part two of the series, how the Affordable Care Act will
affect those who get their insurance through their employers,
To read part three of the series, how the Affordable Care Act
will affect workers who don't have insurance through their jobs,
To read part four of the series, how the Affordable Care Act
will affect Medicaid recipients,