Affordable Care Act: More Affordable AND more Effective Health Care for Seniors

What does the new, federal health care law, the Affordable Care Act, mean for seniors? How will it affect Medicare recipients? Throughout the health care reform debate of the past few years, Medicare has been a significant issue. The Affordable Care Act (“Act”), the law passed by Congress and signed by President Obama this spring, seeks to provide better quality and more affordable care to seniors and Medicare recipients.

To make health care more affordable for seniors, the Act addresses the Medicare Part D prescription drug coverage gap, otherwise known as the “donut hole.” In 2007, over 8 million seniors fell into the “donut hole” and could not receive coverage for their prescription drugs. Under the Act, any seniors who fall into the donut hole this year will receive a $250 rebate check from the government. In 2011, the Act institutes a 50 percent discount on all prescriptions drugs in the “donut hole,” and by 2020, the Act will completely close that gap.

Starting in 2011, the Act provides for free wellness checkups as a preventive care measure. It also eliminates all deductibles, copayments, and other cost-sharing for preventive care in Medicare, in an effort to make preventive care more accessible and attractive to seniors with modest means. The Act also creates a voluntary, long-term care insurance program that will provide a cash benefit to seniors and people with disabilities seeking certain types of long-term care that will allow them to stay in their homes.

In other efforts to make health care more affordable for seniors, the Act will reduce unwarranted subsidies to insurance companies by putting Medicare Advantage payments more in line with the costs of Medicare programs. This will ultimately save Medicare more than $150 billion over the next 10 years. The Act also seeks to reduce fraud and waste within the health care system by expanding the efforts the Department of Health and Human Services and the Department of Justice have already made in the past few years, and giving law enforcement officers more authority to crack down on those engaging in health care fraud. In fiscal year 2009, $2.51 billion acquired through these anti-fraud efforts was deposited in the Medicare Trust Fund, a 29 percent increase over fiscal year 2008. This Act provides more tools to continue and expand the anti-fraud efforts already in place, saving Medicare recipients billions of dollars in the coming years.

The Act does not only seek to make health care more affordable; it also seeks to make health care more effective for seniors. To achieve this goal, the Act seeks to improve the quality of care seniors receive in nursing homes and other long-term care facilities. It creates a standardized form for filing complaints with the State concerning long-term care facilities, and it requires states to develop and implement resolution processes for these complaints. It also establishes a program for national and State background checks of all long-term care facilities employees that have direct access to patients.

This entry is only a brief summary of various parts of the new law. More information can be found here. Current Medicare recipients will be receiving an informational brochure in the next few weeks regarding these programs.

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