Seniors, the ACA and Medicare: For Most the News is Positive
The Patient Protection and Affordable Care Act (ACA) affects every U.S. citizen, including seniors on Medicare. The changes it has brought and will bring are significant, but there remains a lot of confusion over the impact of the ACA on Medicare and seniors.
The good news: Medicare benefits are not only secure, but the majority of seniors will also view the ACA’s impact as positive. Here are some important facts seniors should be aware of:
Medicare coverage is protected. It cannot be reduced or removed, and you can still choose your own doctor.
Through coordinated care, your doctor, hospitals and other health care providers work together to ensure you receive necessary care at the right time.
Preventive services are free. Tests like mammograms and colonoscopies are covered, as well as yearly wellness exams.
The prescription drug donut hole will eventually be closed. The donut hole is the gap between the end of coverage and beginning of out-of-pocket maximums. In the hole, you now receive a 47.5 percent discount on brand-name drugs, and a 79 percent discount on generic drugs. Discounts will increase through 2020. Visit Medicare Prescription Drug Coverage for more information on prescription drug costs.
The Medicare Trust Fund is extended through 2029.
Bonus payments are now being provided to Medicare Advantage plans based on quality ratings, and in 2014, the ACA will require Medicare Advantage plans to reduce the share of premiums used for administrative expenses, meaning more costs will be directed to patient care. Ultimately, premiums are expected to decline as a result.
Need Health Insurance? Here are Some Options
For many of us, 2014 is coming up faster than expected, leaving we procrastinators with the need to find health insurance quickly. So, where do you find health insurance? It may be easier than you think.
Group Plans. If you have coverage through an employer or a network of businesses, no action is required on your part. Your employer, however, will need to take action. While businesses with fewer than 50 employees (more than 90 percent of America’s companies) aren’t required to offer health insurance, those with more than 50 employees must provide affordable healthcare for no more than 9.5 percent of your income. Note that small businesses get a tax break if they offer health insurance to employees.
Individual Plans. Insurance companies will continue to sell plans directly to individuals. The ACA may result in more opportunities to purchase health insurance, but with such a diverse market, you may need guidance from a knowledgeable and reputable insurance professional.
State Exchanges. One of the biggest changes implemented by the ACA, is that every state is required to have an exchange website in place by October 1, 2013. On this site, individuals and small businesses can shop for health insurance plans in their area. For individuals seeking help in accessing and navigating their way around the new state exchange websites, you may want to contact your insurance professional or access online support.
Medicaid. Depending on what state you live in, the expansion of Medicaid may provide you with a health insurance option. This program is geared towards families living below a certain percentage of the poverty line.
As of 2014, anyone without a health care plan will have to pay a penalty. Initially, this is $95 for an individual, $285 for a family of three or more, or 1 percent of taxable income, whichever is greater, but they rise steadily until 2016. Avoid penalties. Don’t wait for 2014; do it now.