On July 30, 1965, Medicare and Medicaid (for low-income individuals and families) were signed into law. These programs, which were part of the Social Security Amendments of 1965, were the culmination of a 20-year journey. Before then, Americans had no healthcare “safety net” in place. To be insured, anyone 65 years or older had to have employer-provided health insurance or a private plan. Otherwise, they were on their own, or at the mercy of family or friends, for medical care.
Medicare was greeted very enthusiastically, and on July 1, 1966, more than 19 million Americans age 65 and older enrolled. Another milestone occurred in 1972, when Medicare extended eligibility to individuals under age 65 with long-term disabilities or end-stage renal disease.
Are you 65 or older? Have you taken advantage of these ACA benefits?
While Medicare (and Medicaid) long enabled valuable health services, the Affordable Care Act has taken healthcare coverage to a whole new level. First and foremost, the ACA established health-insurance exchanges (or, the Marketplace) enabling the uninsured (of all ages) to purchase qualifying coverage, even those with pre-existing conditions. But this law actually offers America’s senior population several unique benefits, and not all of these are as well-known, if at all!
- Down with the “donut hole” – While Medicare-eligible seniors can purchase Medicare Part D for prescription drug coverage, they may be subject to a coverage gap, known as the “donut hole.” Prior to the ACA, Part D paid most drug costs; beneficiaries then paid only 25 percent of that initial level of costs once they’d paid their deductible. But above that amount, Part D paid nothing, and seniors were responsible for all drug costs. Instead, coverage again kicked in once total out-of-pocket spending went above a higher amount. Then, participants would pay a small amount of the cost for prescription drugs above that amount.
But the ACA established a schedule of discounts for both brand-name and generic drugs within this donut hole. In 2015, Medicare participants receive a 55 percent discount on brand-name drugs and a 35 percent discount on generics, respectively. And while seniors don’t pay the discounted amounts, those discounted amounts are counted against the out-of-pocket maximum to calculate where the donut hole ends. Therefore, seniors will only be responsible for 25 percent of their drug costs by 2020. This should also match basic coverage under the standard Part D model, which will basically make the donut hole disappear.
- Annual wellness and preventive care exams for seniors under Medicare – A major selling point of the ACA is that it provides seniors with essential annual wellness and preventive care exams. It’s been found that these exams are effective in reducing or even reversing the need for future illnesses and injuries. Wellness visits are designed to review your medical and family history. They provide a database of routine measurements for patients’ physical condition, along with a list of current healthcare providers and any prescription drugs you take.
As they include personalized health advice, wellness visits can establish lists of risk factors and treatment options for any conditions you have. You’re also able to receive multiple, diverse screenings, including vaccinations, cancer checks and vision tests. While many screenings are free, some may require you to pay Medicare Part B’s normal 20 percent copayment.
- Financial assistance for low-income seniors’ costs – Before the ACA’s establishment, low-income seniors relied on Medicare, and especially Medicaid, for any financial assistance available to cover healthcare costs. This was often difficult, but the new law provides e additional financial options for low-income seniors. For instance, the ACA eliminates cost-sharing provisions for prescription drug coverage for those who receive home-based or community-based care. There may also be some long-term care options to help low-income patients receive home-based care.
- A more secure level of attention and detail – Under the ACA, special care has been taken to ensure that procedures and prescribed medications are medically necessary and carefully considered. By involving a second pair of eyes (or more), doctors, and the Medicare program, in general, can reduce the chances of making costly (and potentially dangerous) mistakes. This provides senior patients with added security and confidence that they’re receiving the proper medical care. It saves patients – and the entire healthcare system – from unnecessary costs, as well.