Health care exchanges, a key part of Obamacare, opened October 1. Technical glitches have only added to the confusion around Obamacare. Many seniors are wondering how Obamacare does and doesn't affect them.
Here's a look at what Obamacare means to those 65 and over.
Know the basics
The Affordable Care Act does not raise the eligibility age for Medicare and health exchanges are not replacing Medicare, says Rebecca Rabbitt, vice president, government programs at Express Scripts, a pharmacy benefit management company.
“If you are over 65 and do not have prescription drug coverage for 2014 through an employer or other provider, enroll in a Medicare prescription drug benefit,” she adds.
You're covered, if...
If you have Medicare you are covered under the requirements of Obamacare. As long as you're enrolled in Medicare, either through traditional Medicare or a Medicare Advantage plan, you won't have to pay a penalty under the Affordable Care Act, says Jacqueline Garry Lampert, a consultant to yourhealthcaresimplified.org, a site devoted to explaining health care reform.
The good news
Under the new law, Medicare now covers recommended preventive services, like mammograms or colonoscopies, without cost-sharing, such as applying a deductible or charging co-insurance, says Lampert. In addition, beneficiaries will now receive an annual “wellness” visit with their doctor, similar to the current “welcome” to Medicate preventive visit, without cost-sharing.
Seniors also now have access to vaccines – such as flu, hepatitis and pneumonia.
The “donut hole” closes by 2020. If your Medicare prescription drug plan includes a gap in coverage, popularly called the “donut hole”, it will be eliminated by 2020, says Lampert.
What you might not like
If you receive your benefits through a private Medicare Advantage plan, you should know that the way the government reimburses these plans for providing your care is changing, says Lampert. Under the current payment system, the government pays about 14% more for beneficiaries enrolled in Medicare Advantage than it pays to provide the same benefits for those enrolled in traditional Medicare.
“The Affordable Care Act makes a complicated series of changes to these payments to Medicare Advantage plans, but the net result will likely mean lower reimbursements for plans with lower quality ratings,” she says.
The impact of these payment changes on you, the Medicare beneficiary, remains to be seen, and the impact is expected to vary across the country, she adds. “Be sure to explore all your plan options during open enrollment each year. Plans change their benefit offerings each year, and these benefit changes could be more pronounced as the payment changes take effect,” she warns.
Beware of scams
“Financial scams of the elderly have been well documented for reasons that are obvious, loneliness (and welcome chatting with a caller); sometimes decline in mental facilities and more trusting natures,” says Debra Speyer, managing partner of Speyer Law, these factors help make the elderly a target for Obamacare scams.
The latest scams she says, include swindlers who pose as government officials, call seniors and tell them they need to sign up again for Medicare, or that they need a new card. They offer to help them fill out the application over the phone. “Armed with the Social Security number, they can open charge cards in that person's name, buying thousands of dollars of merchandise – or, along with a bank statement, a house. Do not speak to anyone calling on behalf of the government. They are not making calls to confirm your information in order for you to stay on Medicare.”
Lampert sees Obamacare as mostly a good thing for those over 65. She says, “The Congressional Budget Office estimates that the changes to Medicare made by the Affordable Care Act extended the life of the Medicare Trust Fund, stabilizing the program for current and future Medicare beneficiaries.”