The Affordable Care Act (ACA) has changed how Medicare works. Under ACA, basic benefits are required for coverage, and costs are lowered.
The History of the Affordable Care Act and Medicare
The ACA legally requires all health insurance plans to meet certain standards for coverage. In regards to Medicare, it has and will continue to streamline and add on benefits and reduce costs.
One of the ways ACA reduced Medicare costs is through the reduction of the Part D coverage gap. Before ACA, Medicare beneficiaries were almost 100% responsible for all prescription drug costs. Now, Medicare contributes more funds each year to cover your out-of-pocket costs when you sign up for a Part D plan.
Medicare Part B now also includes coverage for preventative care because of ACA. Specific benefits must be approved by your doctor, but coverage for these benefits can include:
- Alcohol misuse screenings and counseling
- Annual ‘Wellness’ visits
- Cardiovascular disease screenings
- Certain colorectal cancer screenings
- Certain vaccines (flu shot, pneumococcal shot, hepatitis B shot, etc.)
- Cervical cancer screenings
- Depression screenings
- Diabetes type 2 screenings
- HIV screenings
- Nutrition counseling services
- Obesity screenings and counseling
Medicare Part D and ACA
Medicare Part D recipients have also experienced a great reduction in costs due to ACA. A gap in coverage known as “the donut hole” became a huge problem—it was a gap in which one’s Part D plan met its coverage limit, but had not so far exceeded it to require special help.
In 2019, you would enter the hole when your total costs to the plan equaled $3,820. You got out of it and entered the catastrophic level when costs equaled $5,100.
Part D required a major overhaul of cost and benefit structures to fix the donut hole. Once ACA came into effect, reimbursement started rolling out. Now Part D beneficiaries receive compensation within this donut hole, with improvements on it every year.
ACA and Medicare Advantage
Medicare Advantage is somewhat of an “all-in-one” alternative to Original Medicare. They provide all of the coverage of Parts A and B, as well as doctoral-service coordination and additional benefits. However, before ACA, Advantage plans cost significantly more than Original Medicare.
So, once ACA went into effect, a complete cost-restructuring was required. There have been many legal bumps along the way, but, since 2012, the government has gradually begun implementing cost reduction strategies.
Advantage enrollment did not decrease as many predicted ACA would inflict—and, slowly, costs are going down by 3-6% each year. These changes are minimal, but many other changes have also made big differences.
ACA reformed Advantage, implementing smaller network and higher out-of-pocket cost options, even offering $0 premium plans. Now, there are 21 5-star rated Advantage plans. ACA, then, has greatly improved Medicare Advantage services and costs.
Call Game Changing Benefits for More Insight into Medicare
Learning more about Medicare and the Affordable Care Act helps beneficiaries get the most out of their coverage. If you want more insight into Medicare, or have any questions, call Game Changing Benefits at 972-331-1060.