Obamacare, or the Affordable Care Act (ACA), is a program that helped millions of Americans get health coverage without companies discriminating against pre-existing coverage.
Since 2011, Medicare beneficiaries have received free preventative screenings like colonoscopies and mammograms–where early detection can mean the difference between life or death. In addition to a host of preventive screenings, the law also implemented a free annual wellness visit. These changes were similar to the provisions made to the insurance market for people under age 65: that both group and individual plans must now cover checkups and other screenings at no cost to the patients.
In the days before the Affordable Care Act, most people with Medicare paid a co-payment for preventative services and possibly a percentage of the overall doctor’s bill, depending on their coverage – which could leave them with large out-of-pocket costs. While this might not seem like a huge amount, keep in mind that half of all Medicare beneficiaries only had incomes less than $24,150 per person in 2014! So, for those with limited incomes, many times they went without the screenings which could have prevented much more costly treatments.
The ACA included provisions to close the “doughnut hole,” a coverage gap that exists in Medicare Part D (drug plans). In 2017, the coverage gap begins once the insured and their plan have spent a combined total of $3,700 on covered drugs, and ends when the beneficiary’s own spending reaches $4,950 and the “catastrophic coverage” kicks in. Before the ACA, beneficiaries had to pay 100% of their drug costs in the doughnut hole. Since the law took effect, the amount has shrunk each year and currently the percentage is 40% for brand name and 51% for generics. The coverage gap is slated to close by 2020, at which time the beneficiaries will only be responsible for 25% after they meet their deductible, regardless of their total out-of-pocket costs. Before the ACA came into effect, more than 3 million Medicare beneficiaries hit the doughnut hole, and some were left to split pills, skip does, or go without filling their prescriptions because they simply couldn’t afford the cost.
If the Affordable Care Act is repealed, these important pieces of the law may be in jeopardy. Be careful to pay attention to the details of new legislation and how it may impact your Medicare coverage.
If you have any questions about your Medicare coverage and which screenings are covered, contact SeniorChoices NW to schedule an appointment with a local agent in your area.