ACA & Medicare are both hot topics in the insurance industry. Most people have one or the other to cover healthcare expenses.
The ACA certainly gets most people fired up, one way or another. However, the Affordable Care Act has brought about a lot of changes in health care.
Several years into the ACA and most people agree the changes have been inherently advantageous.
The Affordable Care Act was the first revamp of the Medicare and Medicaid program in nearly 50 years. Also, the general idea was to get more Americans health care at a fair premium.
In some ways, the ACA has been successful. Through the ACA, more than 20 million people have health insurance.
The law of numbers makes the premium affordable, and by insuring everyone, the overall health of Americans improves. With the overall health of American’s growing due to regular health maintenance, the premium amounts would stabilize.
What the ACA means to Medicare beneficiaries
An easy way to stay healthy is to take advantage of the wellness and screening visits covered by your Medicare plan.
With regular checkups, you can find disease and illness in the early stages. Also, early detection results in a higher likelihood of successful treatment.
Raising the bar for hospital standards
The Affordable Care Act grew the standard of care by holding health care providers responsible. A decrease in spending was the result of hospitals that failed the standards of care and efficiency guidelines that are now in place.
Hospitals that want more money are now implementing programs to minimize hospital readmissions and reduce lengthy visits.
Well, hospitals want to get a “piece of the Medicare pie” by coming up with production processes to meet the new standards set by the Affordable Care Act.
To the beneficiary, this means your dollars will buy more services than in years past.
Every three years, Medicare hospitals undergo review; this is done either by CMS or the State to make sure the facility is giving adequate care. Also, the Hospital Readmission Reduction Program reduces the reimbursement rate for the hospital with higher than expected readmission rates.
As a beneficiary with Original Medicare, meaning if you have Parts A and B, then you have met the ACA terms, and you have coverage. You won’t get a penalty.
Those with Part C have met the ACA necessary coverage amounts.
If you only have Part A, then you have met the minimum amount of coverage without a fee.
If you only have Part B, you should know that coverage alone doesn’t meet the Affordable Care Act qualifying coverage requirements. When you file your taxes, there might be a fee.
The fees imposed for not having a qualifying Affordable Care Act plan will no longer apply as of April 2020.
Expanded preventive care benefits
The biggest “win” with the passing of the Affordable Care Act has been the coverage for preventive care. Also, beneficiaries, along with all insured persons that have a qualifying ACA plan, can now appreciate screenings and wellness visits with a zero copay.
Screenings now cover:
- Abdominal aortic aneurysm screening
- Alcohol misuse screenings and counseling
- Bone mass measurements (bone density)
- Cardiovascular disease screenings
- Cardiovascular disease (behavioral therapy)
- Cervical & vaginal cancer screening
- Colorectal cancer screenings
- Depression screening
- Diabetes screenings
- Diabetes self-management training
- Glaucoma test
- Hepatitis B Virus (HBV) infection screening
- Hepatitis C screening test
- HIV screening
- Lung cancer screening
- Mammograms (screening)
- Nutrition therapy services
- Obesity screenings & counseling
- Prostate cancer screenings
- Sexually transmitted infections screening & counseling
- Shots: flu shots, hepatitis B shots, pneumococcal shots
- Tobacco use cessation counseling
- Yearly “wellness” visit
Beneficiaries also get a one time “Welcome to Medicare” preventive visit.
Part D coverage gap
Also, the Part D coverage gap is closing by January 1, 2020. The entire process took a decade, but the prescription coverage gap is almost a distant memory.
Fee for service versus bundled payments
Before the Affordable Care Act, providers sent the bill to the insurance company separately for each service. However, the beneficiary has coverage for all these services now.
With the Affordable Care Act, combining payment options by commercial insurers is a way to reduce expenses. Additionally, bundled payments discourage providers and health care facilities from ordering unnecessary tests or procedures.
The Affordable Care Act & Medicare
Through screening and early detection, a 2014 study indicates the ACA prevented over 50,000 premature deaths in just three years. Premature deaths are deaths before age 74.
Perhaps one of the most notable changes that came from the ACA was the elimination of insurance companies being able to deny coverage for persons with pre-existing conditions.
Beneficiaries with Part A and B have coverage for their preexisting conditions through Medicare. However, when enrolling in a Supplement, you need to apply for the coverage and qualify.
Meaning the insurance company can refuse to cover a pre-existing condition for the first six months.
As well as deny your application for a plan. However, if you’re replacing creditable coverage with a Supplement, the insurance company can’t make you wait.
Also, the ACA is incorporating wellness programs to help more people prevent diseases.
To discuss your options and get help in obtaining the coverage, you should speak to an expert.
Call the number above or fill out an online rate form to discover the best policy!