Affordable Care Act for Seniors

While the Affordable Care Act (ACA) was signed into law in 2010, there is still confusion, particularly in the senior community about how the healthcare law impacts Medicare coverage.

Not Replacing Medicare

The new law established a Health Insurance Marketplace (online exchange) where consumers can go to purchase healthcare coverage. Many seniors are concerned that they are now obligated to purchase coverage through the Marketplace. Medicare isn’t part of the Marketplace. If you are enrolled in Medicare or have a Medicare Part C plan, your coverage will stay the same and you will never need to obtain your benefits through exchanges. It is against the law for anyone to knowingly sell you a health insurance plan through the Marketplace if you are currently enrolled in Medicare.

Essential Coverage

The individual mandate as described by the ACA can be confusing. While it is true that some people who are uninsured or underinsured will be required to pay a penalty, seniors on Medicare do not have to worry. Medicare is considered “essential coverage” and recipients will not be required to add healthcare coverage to an existing plan. Since most seniors are eligible for Medicare coverage at 65, as long as you are enrolled, you will not be responsible for paying a fee under the Affordable Care Act.

Preventive Care

The passage of the Affordable Care Act also means more services for seniors in Illinois, on Medicare, particularly preventive care. Medicare is now required to cover a host of services at no additional cost to you, including immunizations, mammograms, colonoscopies, annual wellness visits, and more – all without a co-pay.

Prescription Drugs

The coverage gap, also called the “donut hole” that many seniors experience with prescription drug coverage can make it challenging to afford medication. Provisions of the Affordable Care Act require Medicare to pay more, which reduces costs for seniors entering the gap. The ACA plans to eliminate the donut hole completely by 2020, but until then, seniors enjoy a 55 percent discount on covered brand name prescriptions and a 35 percent discount on generic drugs until out-of-pocket limits have been reached. While prescription drug costs have decreased for most recipients, costs have increased slightly for individuals who earn more than $85,000 and couples earning $170,000 or more.

References:

https://www.medicare.gov/Pubs/pdf/11493.pdf

MUC18-2016-BCBS