How does the Affordable Care Act affect your Aging Loved One?

The Affordable Care Act (ACA)- or as some call it- Obamacare, attempts to make positive changes to the healthcare system by offering more Americans with affordable health insurance while giving more control over coverage (via the healthcare Marketplace), as well as curbing the growth of healthcare spending overall in the United States. The most important factors of the reform that actually affect us on an everyday level have been buried by the controversy and political uproar. Let’s recognize how the ACA has made dramatic changes in our healthcare system, especially in Medicare, that directly affect America’s seniors in different situations:

Effects the ACA has on an Individual with Medicare (the most popular situation):

Although nobody is automatically entitled to Medicare, most U.S. citizens over the age of 65 have it, or are at least eligible. The ACA is making an estimated $716 billion in Medicare cuts, but that doesn’t necessarily mean that the effects of the reform are all negative. The ACA is reinvesting that money back into Medicare as well as the ACA as a whole in an effort to try to improve the overall health care system. Specifically for seniors, the reinvestment into Medicare attempts to improve care and services.

If you or your loved one already has Medicare, your benefits are expanding under the health care law.

• The addition of preventive benefits such as wellness visits, vaccinations and cancer screenings. Experts say that the goal is to address any declines in physical or mental capacity early on, before someone takes a fall or has a stroke.
• If you or your loved one falls within the prescription drug gap, also called the “donut hole”, you may be able save money instead of paying out of pocket. The ACA institutes a 50 percent discount on brand name drugs (different for generic drugs). In essence, most seniors will find that they are paying less for prescription drug coverage, except for higher-income seniors- they may need to pay more.
• The new healthcare law has made an effort to prevent harmful and unnecessary hospital admissions as well as combating any potential fraud that can happen, which happens against seniors especially. This part of the law invests in fighting waste and abuse, and improving public health.

Note: Medicare is not part of the open marketplace or health insurance “exchange” so that will not pertain to you. However if you or your aging loved one need to enroll or if you are interested in changing your current plan, there is an open enrollment period specifically for Medicare that runs from October 15 through December 7, 2013.

Medicare Changes Demystified

Remember that 49.5 million people in the country, and the majority of seniors today are currently insured by Medicare, so let’s take a look at a few myths and facts on Medicare under the new law:

• The ACA hurts Medicare plan costs- this is not true for everyone. While the ACA is not completely changing Medicare costs, some Medicare plans are changing in 2014 so be sure to find out any changes that may occur with your specific plan.
• The ACA completely changes senior living options- that is a myth. The ACA does not fund the cost of living in facilities, but it does fund new innovative ways of care that can positively affect residents in assisted living communities as well as specialized care likeskilled nursing or home care.
• The ACA has made it so you or your aging loved one can’t choose your own doctor- this is false. You will still be able to choose your own doctor. However doctors will have to shift their focus increasingly on government rules.

If you or your aging loved one does not currently have Medicare, Medicaid, or a health insurance policy through an Employer, this is how the ACA affects you: 

If you do not have any type of health coverage by 2014, you may need to pay a fee. In order to avoid this, follow the steps below:

First, check to see if you or your aging loved one is eligible for Medicare. If your or your aging loved one is in fact eligible for Medicare then you will not need to do anything in the new healthcare Marketplace or “exchange”; Medicare is completely separate from the the healthcare Marketplace.

Then, find out if you or your loved one qualify for Medicaid. (You can qualify for both Medicare and Medicaid). More people then ever will qualify for Medicaid starting in 2014 because it is expanding in many states. Visit your state’s Medicaid website for more information (you may qualify now even if you did not qualify in the past). You qualify for Medicaid based on income and family size. If you’re eligible, you get free or low-cost care and don’t need to buy a Marketplace plan.

What if I already have Medicaid… how am I affected?

If you or your loved one has Medicaid already or is eligible for it, there are a few positive changes that may affect you, depending on if the state you live in has an expanded Medicaid. Expanded Medicaid provisions include: a change in eligibility to enroll in the program (more people qualify), as well as affordable long-term care and community-based services and support- which directly benefits seniors. This will help lower-income seniors with disabilities obtain community services and support so they can continue to live in their home. You or your aging loved one may also begin to see improvements on the quality of care while the cost is reducing.

I don’t qualify for medicare or medicaid… What should I do next?

If you or your aging loved one is not eligible for either and do not have any type of existing coverage, then according to the new law, you should be eligible to check out the Marketplace (or the health insurance “exchange”). The Marketplace is the new way to compare and select affordable health coverage and is one of the biggest factors of the ACA. If you are eligible (which most Americans are), then no plan can turn you away or charge you more because of an illness or health condition.

No Medicare, no Medicaid, and I cannot afford any health coverage programs through the Marketplace…

If you can’t afford any health plan, you can now get low-cost health care at your nearbycommunity health center.

No matter if you or your loved one currently has health insurance or not, the ACA will affect you in some regard, but exactly how it affects you just depends on your current situation. So take a careful look at your existing coverage to see if there will be any changes to it come 2014, and if you’re currently uninsured and do not want to pay a fee in 2014- then check your eligibility for Medicare first, then Medicaid and the health insurance “exchange” system. With so many new and different factors that go into American’s health care programs, understanding these changes can ultimately help curb the amount of stress involved in caring for an aging loved one.

Related Links:
The Official Affordable Care Act Website
Medicare.gov
Do I Qualify for Medicaid?
Navigating Through the Elder Planning Maze