When the Affordable Care Act (ACA), also known as Obamacare, was first introduced to the public, it generated a lot of questions. The ACA touched almost every area of healthcare in the United States, including Medicare, and seniors started to worry that their benefits may be affected.
There were several elements of Medicare reform that were introduced as cost-cutting measures, which opponents of the ACA tried to use to scare seniors into thinking that Medicare might be going away, or limited in some way. The cost-cutting measures put in place were designed to motivate care providers to focus more on quality care and less on a checklist of fees they could charge Medicare. In the end, those changes helped to expand the viability of Medicare by several years.
The Donut Hole
The “donut hole” is a phrase used to describe the gap between the coverage limit for prescriptions and the catastrophic limit that seniors reach when they hit the out-of-pocket maximum in their drug plan. Medicare’s Part D prescription plan only covers a certain amount of each prescription and then leaves the rest for the senior to cover. Over time, Medicare failed to keep up with prescription medication costs, which created the donut hole in the first place.
The ACA directly attacked this coverage gap by offering a 55 percent discount on prescription drugs in 2016. The discount is applied automatically when seniors pay for their prescriptions while they’re stuck in the gap, and it’s scheduled to go up to 60 percent in 2017. The plan is to eliminate the donut hole scenario completely by 2020.
Obamacare added several preventive care measures to Medicare that weren’t guaranteed before. Seniors now get one wellness visit to their primary doctor per year that does not require any co-pays. Procedures such as colonoscopies and mammograms are also covered in full once every year as part of the new wellness portion of the ACA-adjusted Medicare. These preventive checkups and wellness screenings help people to catch problems earlier, saving money over time on medical care. Getting older usually comes with a slate of medical concerns, but it doesn’t have to when you’ve got access to free preventive services.
Medicare and the Marketplace
To protect seniors from fraud, Obamacare includes a few guidelines when it comes to the federal marketplace. Medicare is not available on the federal marketplace, but if you are paying a premium for your Medicare Part A, then you can choose a marketplace plan to go along with your Medicare coverage.
It’s illegal for any company or agent to sell you marketplace insurance when they know you have Medicare. To enroll in Medicare, you’ll sign up directly with Social Security once you become eligible. Seniors who do transition to Medicare from a marketplace plan should contact their marketplace company to cancel their marketplace plan so they don’t get charged the premiums.
The Basics of Trump and Medicare
Donald Trump has indicated that he wants to allow private insurance carriers to sell health insurance across state lines, which is currently not an option. Medicare is a federal program administered by approved insurance companies, so there would be no need to apply the dissolution of state boundaries to Medicare. However, Medicare Advantage is offered through private insurers, and Trump may allow those companies to sell Medicare Advantage policies across state lines.
One area where Donald Trump may offer considerable financial relief to seniors on Medicare is through his proposal to allow foreign drug manufacturers to sell their products legally in the United States. For example, seniors on Medicare may get the option to choose to buy their medications from a Canadian company that offers the same medicine for much less.
The Paul Ryan Angle
Speaker of the House Paul Ryan, a Republican, has big plans for Medicare. Ryan wants to move Medicare from being a federal program that pays medical providers based on a schedule of charges for procedures to a privatized system that rewards quality care.
Ryan’s idea would be to give seniors federal benefits that can be used to buy private insurance, a system that he feels would give seniors leverage in choosing companies that offer higher quality care options. Under what is effectively a voucher program, companies would theoretically be forced to focus on creating quality care options to attract customers.
Donald Trump has been asked several times whether he supports Ryan’s plan or not, but Trump has not confirmed his opinion either way. Tom Price, who’s been slated to become the next Secretary of the Department of Health and Human Services in a Trump cabinet, is a proponent of Ryan’s plan. Between Price and Ryan there may be enough clout to completely change Medicare, a fact that concerns many seniors.
It’s not entirely clear how Trumpcare will affect Medicare. There is plenty of speculation on what could happen, but Trump himself has offered no indication as to how he will treat this particular federal program. Trump has said that he would like to protect Medicare, but it’s anyone’s guess as to what that will actually mean when the new Republican Congress meets in January.