Affordable Care Act in Plain English—New Focus on Prevention

In a recent post, we began a plain-English discussion of what key provisions of the Affordable Care Act of 2010, a.k.a. Obamacare, are all about, and especially how they may affect Americans in general and people of Medicare age in particular.

GavelOur last discussion focused on how the ACA intends to make healthcare more accessible and affordable to the approximately one in seven Americans who are uninsured now.

This time, let’s look specifically at how people on Medicare are likely to be impacted by the Affordable Care Act.

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The ACA and Medicare

While much of the ACA will not likely impact Medicare recipients in any significant way, there are two areas where the impact should be obvious:

  1. Focus on prevention

The American Public Health Association (APHA) identifies a traditional lack of emphasis on prevention as a key reason healthcare reform is badly needed in the United States. According to the APHA, “seven in ten deaths in the U.S. are related to preventable diseases such as obesity, diabetes, high blood pressure, heart disease, and cancer, and 75 percent of our health care dollars are spent treating such diseases. However, only three cents of each health care dollar spent in the US go toward prevention.”

The ACA appears to reflect this outlook. As far as Medicare is concerned, the Affordable Care Act emphasizes the importance of preventive care, and millions of Medicare users have received free preventive health services since the ACA came into effect. Some preventive services were received by Medicare recipients at home instead of in institutional settings. For Medicare preventive services that require coinsurance or copayments, Medicare supplement plans can eliminate out-of-pocket costs, so there is no reason anyone on Medicare should not enjoy access to any preventive services they qualify for.

  1. Helping Medicare Part D recipients through the donut hole

Currently, Part D recipients enter an initial coverage period after their deductible is met. During this initial coverage phase, a recipient’s prescription drug plan pays its share for each covered drug until the combined amount, including the deductible, reaches $2,930.

Once the recipient and his or her Medicare prescription drug plan have reached the combined $2,930 threshold, the Part D recipient is said to be in the donut hole period. During this stage the recipient normally has to pay prescription drug costs out of pocket until total out-of-pocket costs reach $4,700.

One intent of the ACA is to reduce the amount of money Medicare drug plans can charge individuals for drugs when their coverage lapses in the donut hole. Reportedly, reductions of this sort have already saved Medicare consumers significant money in prescription drug costs. Under the ACA, savings on both brand name and generic drugs are slated to continue until 2020, when the donut hole is scheduled to close.

Is the Affordable Care Act impacting you one way or the other? Leave a comment below!

Read our next post about the Affordable Care Act

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