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Medicare and the Affordable Care Act (ACA)

Medicare and the Affordable Care Act (ACA)


medicare act


 October 1, 2013 is an important day for the Affordable Care Act (ACA), also known as the Health Care Reform Law. This is the day many health insurance changes went into effect, including the ability to enroll through the state insurance marketplaces. So how do all these changes affect Medicare Members? The answer is: they likely don’t.

Medicare already meets most of the requirements of the ACA, such as providing essential benefits or not denying someone due to a health condition. Under the ACA, existing Medicare-covered benefits won’t be reduced or taken away. An individual’s eligibility for Medicare won’t change. Medicare is also not a part of the Colorado insurance marketplace ,Connect for Health Colorado. Medicare Members will still have the same Medicare plan and security they have now. They won’t have to make any changes.

Are you a Medicare recipient? Keep reading for answers to some of the most common questions!

What are the changes under the ACA for Medicare beneficiaries?

You may have already noticed some of the changes and not realized they were the result of the ACA. The most important changes affect the Medicare prescription drug benefit (Part D). The coverage gap for prescription drugs (otherwise called the “doughnut hole”), began closing in 2011. The amount you pay will continue to shrink for prescription drugs in the coverage gap each year until 2020. By 2020, your coinsurance for prescription drugs in the coverage gap will be 25%. The ACA also expanded Medicare benefits for preventive services in 2011– including the Annual Wellness Exam benefit – at no cost to you.

What is all the buzz about the new “individual mandate”?

Great news! Medicare coverage already meets this mandate. The mandate requires all U.S. citizens and legal residents (with limited exceptions) to have health insurance coverage or pay a penalty. For Medicare beneficiaries, you don’t need additional coverage and you won’t be subject to penalties.

Are my taxes going to go up to pay for the law?

Your taxes will go up only if you are an individual that earns more than $200,000 or a couple who earns more than $250,000 annually. If you earn less than these amounts, you will not be subject to additional taxes to pay for the law.

Can I qualify for the new premium tax credits created under the ACA?

The ACA created new premium tax credits and cost-sharing reductions to help people with lower to middle incomes pay for individual coverage. The tax credits will be available to people who qualify when they purchase coverage from Connect for Health Colorado. Individuals covered by Medicare are not eligible for the new premium tax credits. However, Medicare beneficiaries who meet certain income requirements may qualify for the “Extra Help” from Medicare to help with the cost of Medicare Part D coverage for prescription drugs.

If I have Medicare and employer-based coverage, what do I need to do?

Generally, there is nothing you need to do as a result of the ACA if you are already on Medicare and have employer-based coverage. If your employer changes the benefits that they offer, they will send a notice about those changes. You can ask your employer’s human resources department how those changes work with Medicare.

Will my Medicare benefit be reduced under ACA?

Under the ACA, your existing RMHP Medicare Cost Plan benefits are not reduced. You may have heard about cuts on the Medicare Advantage (MA) program, which will change how the government pays health insurance companies that offer MA plans. This change may mean that members of a MA plan may see increased premiums or reduced coverage for benefits not covered by Original Medicare.

Where can I learn more about the ACA?

To learn more about health care reform, visit our health care reform website at