Benefits for Seniors

Seniors

Medicare beneficiaries actually gained a lot from Obamacare. But most don't seem to understand this.

Prescription drugs became less costly but not dramatically. Screening tests to detect and manage diseases became more readily available to seniors.

♦ There is no longer a fear of being denied health insurance. If you are over the age of 65 but not eligible for Medicare, you can purchase health insurance even if you have a pre-existing health condition.

Prescription costs will be affected

Seniors on Medicare who need to use a lot of prescription drugs will see some costs go down as the prescription coverage gab is reduced. The gap occurs when prescription costs fall into what is referred to as the "Donut Hole."

The coverage gap applies to both stand-alone Medicare prescription drug plans and Medicare Advantage prescription drug plans, but not everyone will have drug costs high enough to enter it.

♦ What a person actually pays may not go down. Pharmaceutical companies and benefit managers can be expected to try to raise prices to maintain profits.

This coverage gap can be quite complicated to navigate. Seniors need to have some knowledge of this subject.

We created an article to go into greater detail about the Donut Hole.

Some Medicare drug plans already include coverage in the gap. People with these plans should also see some reduction in costs. How much will depend upon how the plans are structured.

Health Screenings and Wellness Visits

Medicare beneficiaries are eligible to receive many preventive services with no out-of-pocket costs.

These include flu shots, tobacco cessation counseling, as well as no-cost screenings.

♦ Copayments and deductibles have been eliminated for preventive services and screenings for cervical cancer, diabetes, colonoscopies, mammograms, bone mass density tests and others.

• Colonoscopies done for screening purposes are covered at no cost. However, a colonoscopy or sigmoidoscopy conducted for polyp removal or biopsy may be coded as a surgical procedure that would then require you to pay something.

Seniors can also get an annual wellness visit so they can talk to their doctor about any health concerns.

♦ A little caution. The wellness visit is covered at no cost but most doctors are creative and will tack on a second office visit charge. If challenged the doctor's office will just say you discussed something "outside" of the scope of the wellness visit. Good luck figuring out what that was.

• Blood work done for a wellness visit is not covered at 100%. If you have a Medicare Advantage plan, you will likely get by with a small copay of $15 to $25 for these blood tests.

Medicare Advantage Plans

Medicare Advantage Plans will now be required to spend at least 85% of their revenue on actual health care with things like advertising and bonuses being more closely monitored.

Advantage plans will no longer be allowed to charge its members more than traditional Medicare for specialized services like chemotherapy administration and skilled nursing home care.

Improving care for seniors after they leave the hospital

The Community Care Transitions Program will help high risk Medicare beneficiaries who are hospitalized avoid unnecessary re-admissions by coordinating care and connecting patients to services in their communities.

The law also puts new requirements on hospitals to make a greater effort to be help their patients avoid being quickly readmitted to the hospital.

Linking payment to quality outcomes

The law establishes a hospital Value-Based Purchasing program (VBP) in traditional Medicare.

♦ This program offers financial incentives to hospitals to improve the quality of care.

Hospital performance is required to be publicly reported, beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients’ perception of care.