The Patient Protection and Affordable Care Act “ACA” was signed into law in March, 2010. The ACA was written to make its provisions become effective over time. Of course, many of the ACA’s provisions have been delayed, garnering significant public commentary. For senior in America, Medicare is primary health care payer, covering 50 million individuals, a full 16 percent of the U.S. population. Until now, the ACA’s mandate that numerous preventive services be provided at no cost may be the provision most noticeable to seniors. No-charge, preventive services include immunizations and several varieties of screening (including abdominal aortic aneurysm, blood pressure, cholesterol, colorectal cancer, depression, type 2 diabetes, HIV, obesity and certain sexually transmitted diseases). This is the first year that the “individual mandate” applies under the ACA. This is the requirement that individuals maintain insurance that provides “minimum essential coverage,” or pay an additional tax on their 2014 federal return, generally required to be filed by April 15 2015. For seniors, Medicare coverage satisfies the individual mandate, protecting them from liability for this new tax.
The ACA does make some direct changes to Medicare, particularly where drug coverage is concerned. High income senior (over $85,000 per person or $170,000 per couple) will be required to pay more for their prescription coverage under Medicare Part D. For lower-earning older Americans, the ACA begins to close the prescription donut-hole.” In 2014, the donut-hole ranges from $2,850 to $4,550. When a Medicare beneficiary hits $2,850 in prescription drug costs, the coverage gap begins. After total out-of-pocket drug costs reach $4,550, Medicare beneficiaries qualify for catastrophic drug coverage, which pays for 95 percent of prescription drug costs for the rest of the year. Under the ACA, the donut-hole is scheduled to shrink each year, disappearing in 2010.
The ACA reduced the amount that Medicare pays to health providers for their services. As a result, many providers have ceased accepting new Medicare patients. However, few providers have stopped seeing their current Medicare patients. As a result senior in a stable doctor- patient relationship may have little to be concerned about, but seniors moving to a new location may have difficulty finding doctors and other providers who will accept Medicare coverage in their new location. The size of this problem is uncertain. Many descriptions of the access challenges are anecdotal. However, where formal studies have occurred, findings indicate the number of doctors taking new Medicare patients has been reduced by 20 percentage points (from roughly 80 percent to 60 percent). To avoid access challenges, before relocating seniors should try to find a primary care provider in the potential new location who will accept Medicare.