The Affordable Care Act (ACA), also known as ObamaCare, has affected every demographic of American society. One group that was particularly concerned about the changes in health care was senior citizens. Many older Americans are retired and have limited income to work with when it comes to medical bills. In addition, seniors often face more significant health challenges than other Americans.
Fortunately, the ACA brought a lot of benefits to the senior population. Medicare coverage remains intact and pre-existing conditions cannot be excluded or charged extra for in private insurance. In addition, the ACA requires Medicare to cover preventive services without cost-sharing and closes the Medicare prescription drug “donut hole.”
Closing the Prescription Drug “Donut Hole”
Seniors face struggles affording prescription drugs under Medicare Part D. This is because, under the standard benefit design, once the combined spending of the senior and the plan reaches a certain spending limit, called the initial coverage limit, the enrollee is responsible for all costs until their spending triggers catastrophic coverage ($4,550 in 2014). Once they reach catastrophic coverage, the plan pays 95% of prescription drug costs, leaving the enrollee responsible for 5%. In that gap between the initial coverage limit and catastrophic coverage, often called the “donut hole,” many seniors struggle to pay for necessary prescription drugs.
The ACA includes a provision that shrinks the gap over time, until it finally disappears. Starting in 2015, seniors will pay 45% for brand name drugs and 65% for generics in the gap. By 2020, the gap will be closed and seniors will pay the standard 25% for prescription drugs all year, with the plan taking care of the rest.
Improving Preventive Care for Seniors
All new individual and small group private health insurance plans, and Marketplace plans are required to cover certain essential health benefits beginning January 1, 2014. One of the benefits is that certain preventive health services must be offered without cost sharing – that is, with no copayment or deductible to be paid by the patient. Preventive services are also provided without cost sharing to Medicare beneficiaries.
Many of these services provided without cost sharing are of special help to older Americans. The ability to get regular screening for cardiovascular disease and diabetes means that many older Americans will discover and control any problems in these areas sooner. This leads to a much better health outcome, which not only saves money for everyone involved, but it allows seniors to live a more fulfilled, joyful life with their families.
Because these preventive care services are provided without cost sharing for Medicare beneficiaries, a barrier is removed for those that might hesitate to seek care. Considering the lower cost of avoiding illness along with the peace of mind knowing the screenings are checking for possible issues, older Americans have a lot to gain from this portion of the ACA.
Many Americans gained access to additional care due to the ACA. Not only do seniors have access to additional options under Medicare and coverage for existing conditions, the donut hole in Medicare Part D is being closed. Additionally, new preventive services provided without cost sharing help older Americans monitor their health and enjoy life more fully. It’s important for seniors to know how to take advantage of all of their benefits – staying informed and active reaps big rewards.