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Affordable Care Act – How It Will Impact Seniors? The Medicare Advantage (MA) program has grown in popularity – especially among seniors. By focusing on prevention and disease management, MA plans help to improve enrollee health outcomes and contain costs. Seniors who are enrolled in Medicare are in compliance with the Affordable Care Act (ACA) and wouldn’t need to replace their coverage with a new plan. They will still have the same benefits and securities already provided. Changes That Beneficiaries •
Will
Impact
Medicare
Prescription drug costs: The first change is the reduction of the cost of prescription drugs; this change was motivated by the “doughnut hole.” It refers to the Medicare Part D coverage gap. Part D provides the much-needed prescription drug coverage
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for seniors at costs far lower than estimated, is highly popular with seniors, and is costing taxpayers much less than originally estimated. Medicare beneficiaries will have to pay for their prescription medications out of pocket once the beneficiary and a Medicare Part D provider has spent a certain amount of dollars on prescription drugs; in 2014 this amount is $2850. A person who has paid $4450 out of pocket for covered drugs including the amount spent prior to entering the doughnut hole, enters catastrophic coverage. In this position, a 5 % co-insurance or co-pay of $2.25 for covered generic drugs and $6.35 for covered brand-name drugs have to be paid. Since 2010, more than 7.3 million seniors and people with disabilities entered the doughnut hole. The ACA aims at closing the “doughnut holeâ€? by 2020. •
Preventive services costs: A second goal of the ACA is to reduce or eliminate the cost of preventive services for all people with health insurance, including Medicare beneficiaries. Each Medicare beneficiary is eligible for an annual wellness exam, as
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•
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well as cancer screenings, immunizations, diet counseling, etc. Medicare fraud, waste, and abuse prevention: A final change provided by the ACA with regard to Medicare is reducing fraud, waste, and abuse. The law provides $350 million over 10 years to enhance anti-fraud efforts. According to the Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2013 published in February 2014 by HHS, the U.S. recovered $4 billion last year through healthcare fraud prevention and enforcement efforts. The report says that the Health Care Fraud and Abuse Control Act (HCFAC) recovered more than $8 for every $1 it spent on healthcare fraud investigations over the last three years. Since medical billing mistakes are so common, almost everyone will fall victim to these errors at some point in their lifetime. Fraudulent medical billing practices may include - submitting claims for services not provided, falsifying claims or medical records and misrepresenting dates, frequency, duration or description of services rendered.
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With the Medicare Losing Doctors
Cuts,
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Seniors
Are
The recent report is that The Affordable Care Act (ACA) will have a negative impact on seniors. A portion of ACA funding is derived by cutting $716 billion from the Medicare program over the next decade - which could reduce seniors' access to care. One provision includes around 24 percent fee reduction for physicians who treat Medicare enrollees. Another provision - the Independent Payment Advisory Board - will have the power to reduce Medicare spending even if it adversely impacts the providers who treat Medicare enrollees. With the lack of availability of doctors as a result of the increase in Medicare cuts from the Obama administration, seniors are left with the choice of keeping the same insurance plan and find another doctor or paying out of pocket or look for another plan where their physician is a member.