Many senior citizens are wondering how the Affordable Care Act affects them – and in fact – many are also confused about the Health Care Marketplace that will be open as of October 1, 2013. We hope this page will help clarify how the Affordable Care Act affects you and your medical coverage now – and in the future.

Fist, let’s clarify a couple of things. Under the Affordable Care Act, you are considered a senior citizen at the age of 65. This is also the age you are eligible to begin receiving Medicare. As a result, any senior citizen who is currently enrolled in Medicare or in the process of enrolling need not use the Health Care Marketplace to find private insurance. You may have been hearing a lot of news about the Health Care Marketplace and the provision in the Affordable Care Act called the Individual Mandate. The Individual Mandate states that all persons who do not have health insurance must purchase insurance no later than January 1, 2014. To reiterate, if you currently have insurance through Medicaid – or are in the process of applying for it – you do NOT need to attempt to purchase insurance elsewhere. You are already covered.

How the Affordable Care Act Benefits You

There are many benefits to the Affordable Care Act which will help you with your medical coverage and benefits as well as your out-of-pocket expenses. Let’s take a look at those here:

  • No Reduction in Benefits: The law has prohibited insurers from reducing or taking away existing guaranteed Medicare covered benefits to seniors. You are also able to choose your own doctor.
  • Elimination of the Coverage Gap: Those who were previously affected by the Medicare Part D coverage gap will receive a $250 rebate. 50% of the gap will be eliminated in 2011 and the gap will disappear completely by 2020. The gap is commonly called the ‘donut hole’.
  • Preventive Care and Health Screenings: The Affordable Care Act includes provisions where all insurers must offer Essential Health Benefits. Insurers are prohibited from charging co-payments, deductibles and co-insurance for these services. Essential health benefits packages must include services and items such as immunizations, preventative care, health screenings, ambulatory patient services, mental health treatment, substance abuse treatment, maternity care, newborn care, prescription drugs, rehabilitative services, chronic disease management, wellness services and pediatric services, including dental and vision care.
  • Trust Fund Extended: The life of the Medicare Trust Fund has been extended. There will be reduction in waste, fraud and abuse, and slowing cost growth in Medicare due to provisions of Affordable Care Act. It will provide seniors with future cost savings on premiums and coinsurance.
  • Rehabilitation/Nursing Care: Long-term care or personal assistance is offered to people with a chronic illness or disability through this act. Personal assistance may include help with dressing, bathing, and using the bathroom.
  • Additional Savings: Seniors will get additional savings on covered brand-name and generic drugs if they are in the Medicare coverage gap until it disappears completely in 2020. The structured savings is designed as follows:
    • 2012: 50% on brand name drugs and 86% on generic drugs
    • 2013: 47.5% on brand name drugs and 79% on generic drugs
    • 2014: 45% on brand name drugs and 72% on generic drugs
    • 2015: 45% on brand name drugs and 65% on generic drugs
    • 2016: 45% on brand name drugs and 58% on generic drugs
    • 2017: 40% on brand name drugs and 51% on generic drugs
    • 2018: 35% on brand name drugs and 44% on generic drugs
    • 2019: 30% on brand name drugs and 37% on generic drugs
    • 2020: 25% on both brand name and generics
  • Review: It’s important for all seniors to review their Explanation of Benefits (EOB) notice and work with their drug plan to correct their record in order to get maximum benefits.