Benefits for Seniors

Benefits for Seniors

Tue, 11/09/2021 - 11:45

Seniors on Medicare stand to gain quite a lot because of Obamacare. Most seniors really don't know this.

Benefits for Seniors


Medicare beneficiaries stand to gain from Obamacare.

Prescription drugs will become less costly and screening tests to detect and manage diseases will become more readily available to seniors.

♦ There will no longer be 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

For seniors already on Medicare, one of the largest benefits will be lower prescription costs by closing of the prescription coverage gab that 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.

♦ August 2018
It has been leaked that pharmaceutical companies are vigorously working behind the scenes with Republican congressmen to undo changes put in place by the 2018 budget bill. The pharmaceutical companies are complaining the changes were too generous to seniors.

♦ November 2021
The House passed the Build Back Better Bill which now goes to the Senate. It's future is not certain. If it passes it will allow a small amount of price negotiation.  But prices would not take effect until 2025 and then only for the first 10 drugs.

• The negotiation process would apply to no more than 10 (in 2025), 15 (in 2026 and 2027), and 20 (in 2028 and later years) single-source brand-name drugs or biologics that lack generic or biosimilar competitors. These drugs would be selected from among the 50 drugs with the highest total Medicare Part D spending and the 50 drugs with the highest total Medicare Part B spending. The negotiation process would also apply to all insulin products.

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 will be eliminated for preventive services and screenings for cervical cancer, diabetes, colonoscopies, mammograms, bone mass density tests and others.

• Colonoscopies done for screening purposes will be 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.

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