Dr. Toni P. Miles, a professor at the University of Louisville School of Medicine, and Robert Phillips, a policy expert at The California Endowment, address four frequently asked questions about seniors and their benefits under the Patient Protection and Affordable Care Act signed into law in March 2010.
Question: A lot of seniors are worried that the new law will cut Medicare benefits and make it harder for those in the program to have good health care.†Is this true?
No. The law guarantees there will be no reductions in basic Medicare benefits. As you know, Medicare is a health insurance program for those who are 65 or older, some disabled people under 65, and anyone with end-stage kidney disease.
In fact, starting on Jan. 1, 2011, seniors enrolled in Medicare or Medicare Advantage won’t have to pay any out-of-pocket costs for preventive care such as mammograms, cancer screenings, and annual physical exams.
Many people worry about what they will do if they get a debilitating illness that requires long-term care. Will they be able to stay at home and be cared for instead of ending up in a nursing home?
Yes. The new health care law creates a new insurance program called the Community Living Assistance Services and Support (CLASS) program. CLASS increases your long-term options to live independently if you have or develop a qualifying disability.† For example, this insurance can be used to help pay for assisted living care and home modifications.
Starting in 2012 or 2013, you will first need to enroll in the CLASS program. After paying premiums for at least five years and meeting several eligibility requirements, you will be eligible for benefits.
Many who are on Medicare Part D end up spending hundreds of dollars each month to pay for their prescription drugs.† How will the new law affect them?
The new law will close the doughnut hole.
Starting in January 2011, pharmaceutical companies will provide a discount of 50 percent on brand-name drugs to low- and middle-income beneficiaries who find themselves in the doughnut hole. Over time, the doughnut hole will start shrinking and ultimately disappear entirely in 2020.
This year, Medicare beneficiaries who hit the doughnut hole received a $250 rebate check as part of the new law.† But you’ll still have to pay any remaining costs while in the doughnut hole, potentially hundreds of more dollars.
Will there be any changes to Medicare Advantage for those seniors that have it?
Yes.† The extra payments that privately run insurance plans have been getting from Medicare will phase out over the next several years, starting in 2011. This could change your benefits or your costs for Medicare Advantage.† By 2018, all private Medicare Advantage plans will get about the same amount per member as original Medicare spends, however Advantage plans that provide high-quality care and services will get bonus payments.
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