Medicare Watch

Affordable Care Act Benefits Millions of Americans

The Supreme Court could announce a ruling on the constitutionality of the Affordable Care Act (ACA) as early as next Monday. While the outcome of the decision remains uncertain (the Court could uphold or strike down various provisions, or keep or overturn the law in its entirety), what is clear is that the ACA has provided benefits to millions of Americans across all age ranges.

Thanks to the ACA, Medicare beneficiaries now have more affordable access to needed health services and prescription drugs. The law closes the Medicare prescription drug coverage gap, also known as the doughnut hole. By 2020, the coverage gap will be phased out entirely. Before the ACA, Medicare beneficiaries who reached the doughnut hole paid 100 percent of the cost of their medications out-of-pocket. In 2012, people who reach the coverage gap will receive a 50 percent discount on brand name drugs and a 14 percent discount on generics. Since the passage of the ACA in March 2010, more than 5.5 million people with Medicare have saved over $3.5 billion on prescription drug costs.

In addition, the law has increased the number of preventive services older adults and people with disabilities can receive for free, regardless of whether they have Original Medicare or a Medicare private health plan, also known as a Medicare Advantage plan. Preventive benefits with no cost-sharing requirement include mammograms, certain colonoscopies, prostate cancer screenings, depression screenings, obesity screenings and counseling, diabetes screenings and screenings for heart disease. Through the creation of the Annual Wellness Visit, the ACA also gives Medicare beneficiaries the opportunity to meet with their doctors each year to discuss a preventive care plan based on individual needs. This year alone, over 14 million people with Medicare have received at least one free preventive service. If the ACA is overturned, older adults and people with disabilities may see their health care costs rise and their access to needed services diminish.

The ACA also strengthens Medicare’s financial outlook without decreasing beneficiaries’ access to services or shifting extra costs to them. The law extends the lifespan of the Medicare trust fund; if the ACA is repealed, the fund will expire in 2016, rather than in 2024. The law achieves savings through its efforts to attack waste, fraud and abuse in the Medicare program and promote increased efficiency and quality of care and coverage. For example, the ACA gradually reduces overpayments to Medicare Advantage plans while still requiring Medicare Advantage plans to provide coverage that is at least as good as Original Medicare’s. In addition, to encourage greater efficiency, the ACA slows annual increases in Medicare payments to hospitals, skilled nursing facilities and home health agencies. However, the law does not cut existing payments to Medicare providers and actually increases payments for primary care.

Read the Medicare Rights Center’s fact sheet, “The Affordable Care Act: Before and After.”

Read a live blog of the Supreme Court’s decisions.

MedPAC Recommends Proposals to Restructure Medicare Benefit

Last week, the Medicare Payment Advisory Commission (MedPAC) released its annual report to Congress, which contains recommendations for changes to the Medicare program, as well as recommendations for 2013 payment rates for Medicare providers. The report focuses on changes that could be made to Medicare’s benefit structure, that MedPAC states could reduce the growth of future Medicare spending. These recommendations include creating a combined deductible for Part A and Part B services, replacing coinsurances with standard copayments based on the type of provider and service accessed, instituting a limit on beneficiaries’ out-of-pocket spending and adding a surcharge to supplemental coverage, including Medigap policies and retiree plans.

According to the report, supplemental insurance may protect beneficiaries from high out-of-pocket spending, but it also leads to increased utilization of Medicare services. In the report, MedPAC states that because many supplemental plans cover a majority of Medicare’s cost-sharing requirements, beneficiaries have reduced incentive to weigh decisions about their use of health care services. MedPAC recommends restructuring the Medicare benefit to include an additional charge on supplemental insurance; according to the commission, this charge would recoup some of the costs associated with increased utilization of services.

While MedPAC’s proposals would provide some savings to the Medicare program, these savings would come at the expense of most Medicare beneficiaries, who would likely see an increase in their out-of-pocket costs. On average, people with Medicare spend three times more on health care costs than do people without Medicare, and half of all Medicare beneficiaries have annual incomes below $25,000. Any increases in out-of-pocket expenses may lead some beneficiaries to forego necessary care. An out-of-pocket limit may protect some beneficiaries from huge health care bills, but the annual limit MedPAC recommends in its June report is $5,000—an amount so high that most people with Medicare would not benefit from such protection.

Read the fact sheet on MedPAC’s June 2012 report to Congress.

Read the full MedPAC report.

Medicare Reminder

Medicare will cover yearly screenings for depression, performed by a doctor or other provider in a primary care setting. These screenings will not be covered if you are screened in an emergency room, skilled nursing facility or as a hospital inpatient. If you have Original Medicare, you will not have to pay a deductible or coinsurance for the annual depression screening, as long as you see doctors who accept assignment. If you are enrolled in a Medicare private health plan, also known as a Medicare Advantage plan, you will similarly have no cost-sharing requirement as long as you see an in-network doctor.

The annual depression screening includes a questionnaire that you complete yourself or with the help of your doctor. The questionnaire is designed to indicate if you are at risk or have symptoms of depression. Depending on the results of the questionnaire, your doctor may complete a more thorough evaluation to assess whether you suffer from depression.

The Welcome to Medicare Visit and your first Annual Wellness visit require that your doctor review your potential for depression or other mental health conditions. However, these visits do not require your doctor to screen you for depression. During a review, your doctor discusses your risk factors, such as a family history of depression.

If you need further evaluation to diagnose your condition or if you need mental health treatment, you will be responsible for cost-sharing. The amount you pay depends on the type of care you get.

Learn more about Medicare coverage of screenings for depression at www.medicareinteractive.org, or call our helpline at 800-333-4114.

Spotlight

The Kaiser Family Foundation (KFF) recently released an issue brief examining Medicare beneficiaries’ utilization of dental services. While Original Medicare does not cover routine dental care, some beneficiaries have access to dental coverage through supplemental insurance, including Medicaid and employer-sponsored retiree plans. Other beneficiaries may receive coverage through private dental insurance policies or Medicare private health plans, also known as Medicare Advantage plans. According to the report, Medicare beneficiaries who accessed dental services paid, on average, almost $700 out-of-pocket for care in 2008. In the same year, many others delayed or did not receive dental care due to cost concerns.

Read the KFF report, “Oral Health and Medicare Beneficiaries: Coverage, Out-of-Pocket Spending, and Unmet Need.”