How will the Affordable Care Act (ACA) affect Me?

How Will the Affordable Care Act (ACA) affect Me?

I am often asked about the Affordable Care Act (also known as Obamacare) and how it will impact my clients with Medicare.  Good question, and we probably won’t know until it is fully implemented and has been in effect for a while.  However, this is what we do know:

  • It started to be implemented in 2010 and should be fully implemented by 2014.  Most changes involving Medicare are already being implemented.
  • It is the ACA that will eventually eliminate the “donut hole.”   It started with a $250 rebate check to those who hit the coverage gap in 2010.  In 2011, brand name drugs were subsidized 50 % and generic prescriptions saved 7%.  Each year, the gap will close further so that in 2020, the donut hole will disappear.  (This does not mean that prescription drugs will be free – you still will pay approximately 25% of the cost.)
  • The ACA requires that insurance policies, including Medicare Parts A & B, cover preventative care for adults with no co-pays or deductibles (2011).
  • Under the Affordable Care Act, your existing Medicare-covered benefits will not be reduced or taken away.
  • You still should be able to choose your own doctor.

It is this last point that concerns me for a couple of reasons:

  1. In 2014, there will be a lot more insured people in this country.  The ACA will make it possible for many people, who could not previously afford or qualify for coverage, to obtain insurance.  Of course, they will want to see the doctors too.  Will it be harder to get an appointment?
  2. Medicare providers are already limited by law to collect in full for their services.  We already have a shortage of physicians who will see Medicare patients due to reimbursement issues. The Affordable Care Act is scheduled to further reduce their compensation.  Will even more doctors stop seeing Medicare clients?
  3. Reimbursement for Medicare Advantage Plans have been cut every year since its implementation in 2006.  If Medicare Advantage plans continue, they will probably be set up as HMO’s, the most cost-effective model.  These plans generally require that you see a doctor that is “in network”, again, limiting your ability to choose your own doctor.

Most important of all, is that the Affordable Care Act is supposed to make Medicare more secure and control rising costs.  Time will tell.