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Aren’t We Too Young to Worry About This?

According to the Centers for Medicare and Medicaid Services, there are five little things we should all know about Medicare and the Affordable Care Act, whether we want to or not.  Their reasoning is pretty sound: if you aren’t on Medicare now, you may soon be – or maybe a sibling, a mother-in-law  or grandparent is enrolled.  With all the health care flap and panic, there are important questions about how the system works, what it costs,  who benefits and in what way, and what’s coming up in the next few years.  Good health care serves us all, young, old and in the middle.  And remember, 2014 is the looming Mayan calendar event of health care reform.  So, here goes:

1.  It means you get all sorts of preventive services at no charge. Seriously, at no charge, no co-pays, no cost-sharing.  You have access to free preventive screenings and services like mammograms and colorectal cancer along with a free yearly wellness visit.  You can easily tweak and update your individual prevention plan as your changing health needs require.

2.  It provides incentives for your doctors and health care professionals to work together.  By encouraging and supporting patient-centered care, the law makes it easier for your health care team to work together by providing them with support and resources.  Coordinating care and putting you and your team in touch with community services and support means that your hospital stays are shorter, your likelihood of being re-admitted is lessened and you get better care from home.  Win/win/win.

3.  It strengthens Medicare Advantage.  Under the Act, you will be protected from large premium increases, or benefits decreases, if you have Medicare Advantage.  Changes in your health plans are reviewed by Medicare even before those changes go into effect to make sure they are reasonable.  If not reasonable, they don’t happen.  Beginning in 2012, Medicare Advantage plans will have ratings; plans rated with three stars or more will receive a bonus, part of a broad national effort to improve quality and accountability.

4.  It helps you access the care you need.  The Affordable Care Act increases the number of primary care physicians, nurses and physician assistants, meaning there will be better access to care.  Support for community health centers will continue to increase, along with expanded training opportunities, student loan forgiveness and bonus payments.  The goal is to serve some 20 million new patients.  And, of course, you can still choose your doctor.

5.  It makes prescription drugs far more affordable.  Perhaps you have heard of the coverage gap known as the ‘donut hole‘, a most unpopular feature of Medicare Part D coverage.  Under the Act, this notorious gap is gradually closed.  Starting in 2011, there was an automatic 50% discount on covered name-brand drugs, a discount applied at your pharmacy counter – you did not have to do anything to get it.  There is also a 7% discount on generic drugs while in the dreaded ‘donut hole’.  And here is the schedule for the rest of the phase-out:

  • 2012: You will pay 50% for brand-name drugs and 86% for generics.
  • 2013: 47.5% for brand-names and 79% for generics.
  • 2014: 47.5% for brand-names and 72% for generics.
  • 2015: 45% for brand-names and 65% for generics.
  • 2016: 45% for brand-names and 58% for generics.
  • 2017: 40% for brand-names and 51% for generics.
  • 2018: 35% for brand-names and 44% for generics.
  • 2019: 30% for brand-names and 37% for generics.
  • 2020: 25% for brand-names and 25% for generics.
In order for all of this to work, you (or a loved one)  need  to be enrolled in a Medicare Advantage plan with an Rx plan or a Medicare Rx drug plan; you don’t get Extra Help (the Medicare program to help those with limited financial resources pay for their drug costs); you have reached the coverage gap.  If you believe you have reached that gap and you didn’t get the discount, review your next EOB (Explanation of Benefits) notice and see what’s up.  Be sure your drug records are up to date and correct.  And even though you (or a loved one) pay only 50% of the cost of a name-brand medication, the entire drug cost will be credited towards the amount needed for qualify for catastrophic coverage.  
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3 responses to “Aren’t We Too Young to Worry About This?

  1. Pingback: Open enrollment cutoff for Medicare plans moves up « InsuranceSCNow.com

  2. Pingback: Health Care Reform 2012

  3. Pingback: Open enrollment cutoff for Medicare plans moves up | InsuranceSCNow.com

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