How Does Obamacare Affect Medicare Advantage Plans?

The Affordable Care Act, aka Obamacare, brings with it a whole range of changes that affect the way healthcare is obtained, purchased, and provided for millions of Americans in the United States. Among the many components of the new law is how it impacts Medicare and Medicare Advantage Plans. The Affordable Care Act doesn’t implement any new sweeping changes, but it does provide additional benefits, more ways for you to save money on prescriptions, and increased support and resources for physicians and specialists to deliver the care that seniors need most.

Under the new mandates, those who have Medicare and Medicare Advantage should be informed of the new updates and how they may affect coverage options. It can all be slightly confusing and you may have questions as to what you need to do now that the Affordable Care Act has been enacted into law and the various proposed adjustments to coverage are starting to take effect.

Well, wonder no more. We have the answers that you’re looking for right here and we aim to make them as simple and straightforward as possible.

Medicare and the Affordable Care Act
The first and most important thing to know about Medicare and how it relates to the Affordable Care Act is that the new law is not meant to replace your Medicare coverage in any way. It is not a part of the new Health Insurance Marketplace established under the law. If you currently have Medicare coverage you are not required to make any changes or seek out new coverage under the Marketplace.

Simply put, if you have Medicare, keep it. The only changes that will affect your coverage are found in the new reforms that expand the protections, financial support, and benefits that seniors can now enjoy under the revamped program. You don’t have to change your plan in order to take advantage of these added benefits.

Provisions of the Affordable Care Act
Under the Affordable Care Act, every American is required to have some form of health care insurance in place that meets the basics of “minimum essential coverage” as defined by the regulations of the new law. For those who currently have Medicare, the minimum essential coverage mandates apply to just certain parts of the program. Those who have Medicare need to be cognizant of what their coverage provides so that they may comply and avoid the penalty fee at tax time.

Seniors with Medicare Part A (Hospital Coverage) or Medicare Part C (Medicare Advantage) are considered fully covered under the minimum essential coverage regulations of the Affordable Care Act. If you have either of these forms of Medicare, the law does not require you to make any changes to your existing coverage and you will not be penalized for being inadequately insured.

However, if you only have Medicare Part B (Medical Insurance), you will need to make a change to your coverage or add a supplemental policy. That portion of Medicare does not meet the standards for minimum essential coverage under the new law and you could be subject to a fine.

Those who carry Medigap insurance or the Medicare Part D drug plan are in the clear as well, since you must have Medicare Part A in order to obtain these types of coverage. Therefore, you are in compliance with the new mandates under the Affordable Care Act and no additional action is necessary.

Improvements Under the Affordable Care Act
Now that the Affordable Care Act has been implemented, there have been sweeping changes to the healthcare industry that make it easier for consumers to get medical coverage. That includes seniors who rely on Medicare for insurance. The new law means much-needed improvements to their health plans as well.

Although most forms of Medicare require no additional action or replacement of the current plan, there are some positive shifts in what that coverage provides to those who are insured through this program.

For starters, all of the same benefits and protections you’ve come to expect from Medicare are still in place. Nothing has changed there.

What has changed are the increase in services you can now also expect to receive with Medicare coverage. The Affordable Care Act has expanded your plan to cover things like mammograms, colonoscopies, and other preventive services such as annual wellness visits. You can now access these services without the need to pay any co-pays or deductibles under Part B.

Prescriptions are also cheaper under the Affordable Care Act. Name brand drugs are available at discounts of up to 55% for those buying under Part D if they belong to the so-called “donut hole“. With the new law in effect, your discounts are applied automatically, there are no applications to fill out or enrollments. Your savings are waiting for you when you pay for your medications. One thing to keep in mind is that the donut hole will be closed completely by the year 2020.

The most important facet of the new Medicare improvements is that they bring longevity to the program. A 12-year extension to the Medicare Trust fund has ensured that the program will be fully funded to at least 2029. The Affordable Care Act implements mandates to combat fraud and abuse and brings down the costs associated with Medicare to help you save money.

In addition, the new laws introduce initiatives that provide care coordination support for your physician. This means that resources are in place to keep your treatments consistent and on-going, without any gaps or missed sessions due to a lack of funding.

What About Premiums?
Many of you may be wondering if all of these new changes are going to affect your monthly premiums. The answer is no, for the most part.

Those who might see a change could likely pay less, not more, for Part B premiums. While many will see their premiums go mostly unchanged, high income seniors making $85,000 individually or $170,000 as a couples will pay a bit more each month. But this has nothing to do with the Affordable Care Act, as the rise in costs was going to happen regardless of the new law.