Many seniors and their families are concerned that Medicare changes in the new health reform legislation – The Affordable Care Act signed into law in March 2010 by President Obama – will decrease their benefits or somehow weaken the program.
The federal government, however, has made it clear that your guaranteed Medicare benefits will not change because of the new law — whether you get them through Original Medicare or a Medicare Advantage plan. And, there are no changes in eligibility requirements.
Depending on your health-related needs, you will most likely see new benefits and cost savings, and a greater emphasis on quality to make sure that you get the care you need from competent healthcare providers.
The following are some of the more significant changes to improve your benefits and your care, and to make the Medicare program more cost-effective and solvent:
- More affordable prescription drugs due to cost savings in the Part D coverage gap.
- New preventive benefits to help you stay healthy such as a free annual physical and screening for colon and breast cancer.
- Your choice of doctor will be preserved and Medicare will implement programs to try and increase the number of available primary care physicians.
To learn more about these changes read: Medicare Changes and Health Reform.
Additional Improvements for You and Your Family
Other provisions in the Affordable Care Act may have a significant impact on you as a Medicare beneficiary and on family members who either help care for you or who may still be a dependent. Additionally, many families have one spouse on Medicare and a younger spouse not yet eligible. These additional health reform improvements/changes include:
Improved Chronic Care
Medicare will help develop community-based health teams to provide you with patient-centered care so you won’t have to see multiple doctors who don’t work together. And, if you are hospitalized, the new law may also help you return home successfully — and avoid going back to the hospital — by helping to coordinate your care and connecting you to health-related services and supports in your community.
Better Long-Term Care Choices
The health reform legislation includes the Elder Justice Act, which provides new tools and resources to help prevent and combat elder abuse and neglect. And, to help improve the quality of nursing homes, the legislation includes the Patient Safety and Abuse Prevention Act that creates a national program of criminal background checks for persons seeking employment in nursing homes and other long-term care facilities.
The law also creates a new voluntary insurance program called CLASS to help you pay for long-term care.
If you also are on Medicaid you may receive improved home- and community-based health care options; and, your spouse will no longer be forced into poverty if you need such services.
Help for People with Pre-existing Conditions
Insurance companies will be prohibited from denying coverage due to a pre-existing condition for children starting in September 2010, and for adults in 2014. If you have a grandchild with asthma or diabetes, you will not have to worry about their ability to join a health plan.
And, if you have a pre-existing condition, no health insurance, and are not yet eligible for Medicare, the new law provides affordable health insurance through a transitional high-risk pool program in your state.
Expands Health Coverage for Young People
Young people up to age 26 can remain on their parents’ health insurance policy starting in September 2010. The new law requires health plans that offer coverage to young adults on their parents’ plan to make that coverage available until the adult child reaches the age of 26. This may be very helpful if you have a grandchild or child who recently graduated from college and can’t get a job.
Access to Healthcare Services
The U.S. has a shortage of primary care physicians (PCPs), which may get worse as more people have health insurance. To help assure that you will be able to find a physician, the new law will attempt to increase the number of PCPs, nurses, and physician assistants to provide better access to care through expanded training opportunities, student loan forgiveness, and bonus payments.
The new law also provides funds to support community health centers, allowing them to serve some 20 million new patients.
Financial Changes to Medicare Advantage
Medicare Advantage plans cost the federal government more than traditional Medicare and some in Congress have concerns that private insurance companies that offer these plans make too large of a profit. To address these concerns, the new health reform legislation requires some financial changes in the program. These were outlined in a newsletter sent to Medicare recipients in May 2010:
- Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than Original Medicare. These additional payments are paid for in part by increased premiums by all Medicare beneficiaries—including the 77% of seniors not enrolled in a Medicare Advantage plan.
- The new law levels the playing field by gradually eliminating Medicare Advantage overpayments to insurance companies.
- If you are in a Medicare Advantage plan, you will still receive guaranteed Medicare benefits.
- Beginning in 2014, the new law protects Medicare Advantage members by taking strong steps to ensure that at least 85% of every dollar these plans receive is spent on health care, rather than administrative costs and insurance company profits.
Note: Some of the content in this article is based on information provided by the Centers for Medicare and Medicaid Services, the federal agency responsible for Medicare and the implementation of changes in the Medicare program required by The Affordable care Act.
