HEALTH CARE LAW BENEFITS TEXANS WITH MEDICARE
By BOB MOOS/Southwest public affairs officer for the Centers for Medicare & Medicaid Services
We hear a lot of back and forth these days about the Affordable Care Act – the federal health care law – but not much about how it affects people with Medicare.
When you sort through all the rhetoric, one thing is clear: The two-year-old law contains some real benefits for those who get their health insurance through Medicare.
Take the “doughnut hole” in Medicare’s prescription drug program.
During the first few years of the drug benefit, many seniors had to bear the full cost of their prescriptions once they reached this gap in coverage. It was a burden for most.
But under the Affordable Care Act, seniors who fall into the hole are getting bigger and bigger price breaks on their drugs each year. By 2020, the gap will disappear.
This year, for instance, you get a 50 percent discount on your brand-name drugs and a 14 percent discount on your generics while you’re in the doughnut hole.
Those savings have added up to $197 million for almost 300,000 Texans with Medicare over the last year. That’s an average savings of $661 per person.
The Affordable Care Act also helps people with Medicare by eliminating out-of-pocket costs for many preventive services that detect problems early, when they’re most treatable.
Medicare now offers a long list of free screenings, such as for cancer, cardiovascular disease, diabetes and osteoporosis, as well as free shots for the flu and pneumonia.
There are also new screenings and counseling for alcohol abuse, depression and obesity.
The health care law creates another important benefit for people with Medicare -- a free annual wellness visit with your doctor to keep you healthy.
The check-up includes routine measurements like your blood pressure, a review of your prescriptions and medical history, and an assessment of any risks to your health.
The annual visits follow the “Welcome to Medicare” exam you can get during the first year you sign up for Medicare’s Part B outpatient coverage.
More than 2.2 million Texans with Medicare received free preventive services – such as colonoscopies and mammograms – or a free wellness visit last year.
Because of new financial incentives the Affordable Care Act provides insurers, seniors also can expect to see better quality in their private Medicare Advantage health plans.
For several years, Medicare’s website – medicare.gov -- has posted quality ratings for Medicare Advantage plans to help beneficiaries make informed choices.
Now, to further motivate insurers to improve their performance, Medicare will pay bonuses to plans with higher quality scores. Medicare also will let seniors switch to the top-performing plans year-round instead of during just the fall open enrollment period.
The health care law also strengthens consumer protections. No longer can Advantage plans charge you more for some services (like chemotherapy) than if you were in traditional Medicare.
To make sure the patient comes first, the government also will require the health plans to restrict the share of premiums they can use for their administrative expenses and profits.
Finally, the Affordable Care Act helps stop Medicare fraud with tougher screening procedures for health care providers, stronger penalties for crooks and new technology for crime-fighters.
The government is now using sophisticated computer software to identify patterns of fraud and target criminals. The same kind of software has helped credit card companies go after con artists.
The anti-fraud efforts recovered $4.1 billion last year – money that can be returned to the Medicare trust fund to extend its life and make the program stronger.
All told, the average person with Medicare will save $4,200 over the next decade because of the two-year-old health care law. That’s welcome news for anyone on a limited budget who struggles with the chronic illnesses that come with age.