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 essentially advantageous.
The Affordable Care Act was the first revamp to the Medicare and Medicaid program in nearly 50 years. Also, the general idea was to get more Americans health coverage at a reasonable premium. In that regard, the ACA has been successful. Through the ACA more than 20 million people have health insurance.
When we all pull together the law of numbers dictates the premium can be affordable and with everyone insured, the overall health of American’s will improve. With the overall health of American’s improving due to regular health maintenance, the premium amounts would stabilize.
What the ACA means to Medicare beneficiaries
An easy way to stay healthy and increase your longevity is to take advantage of the wellness and screening visits covered by your Medicare plan. It’s expected that through regular checkups and screenings, disease and illness can be caught 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 improved the standard of care by holding health care providers accountable. A reduction 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 ensure they continue to get “piece of the Medicare pie” they are encouraging their team members to come up with production processes to meet the new standards set by the Affordable Care Act. To the Medicare beneficiary, this means your dollars will buy more services than in years past.
Every 3 years Medicare hospitals undergo review; this is done either by CMS or the State to make certain the facility is providing acceptable care. In addition, the Hospital Readmission Reduction Program reduces the Medicare reimbursement rate for the hospital with higher than expected readmission rates.
As a Medicare beneficiary with Original Medicare, meaning if you have Medicare Parts A and B then you have met the ACA requirements and you have the required coverage. You will not be charged a penalty.
Medicare beneficiaries enrolled in a Medicare Advantage Plan, also known as Medicare Part C have met the Affordable Care Act obligatory coverage amounts.
If you only have Medicare Part A (the hospital insurance), then you have met the minimum amount of coverage will not be imposed a fee.
In a situation where you only have Medicare Part B, you should know that coverage alone does not meet the Affordable Care Act qualifying health coverage requirements. Fees can be imposed when you file your taxes. 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, Medicare 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
Medicare beneficiaries also receive a one time “Welcome to Medicare” preventive visit.
Part D coverage gap
In addition, the Medicare 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. The Medicare beneficiary has coverage for all these services. This was especially true when the person didn’t have any cost share.
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 it’s estimated the Affordable Care Act prevented over 50,000 premature deaths in just a 3-year period. Premature deaths were defined as deaths prior to age 74.
Perhaps one of the most significant changes that came from the Affordable Care Act was the elimination of insurance companies being able to deny coverage for persons with pre-existing conditions.
Medicare beneficiaries with Medicare Part A and B have coverage for their preexisting conditions through Original Medicare. However, when enrolling in a Medicare Supplement plan, you will need to apply for the coverage and qualify.
This means the insurance company can refuse to cover your pre-existing condition for the first 6 months. As well as deny your application for a Medigap plan. However, if you’re replacing your creditable coverage with a Medicare Supplement plan, the insurance company can’t make you wait.
To discuss your options and get assistance in obtaining the most comprehensive coverage options to meet your changing needs, you should speak to a licensed insurance professional. Call the number above or fill out an online rate form to discover the best policy available to you!