The Affordable Care Act and Medicare: What to Expect

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The Affordable Care Act (ACA) is a law that helps Medicare patients in many ways. If you are on Medicare, read on to find out more information about what the law means for you.

Am I eligible for Medicare?

Medicare eligibility rules have not changed. If you are 65 or older, you’re eligible for Medicare. People of all ages who have end-stage renal disease are also eligible for Medicare. Some people who are disabled and are younger than 65 may also be eligible. Visit the Medicare website to check if you are eligible for Medicare.

I am a Medicare patient. How does the health care law affect me?

If you belong to a traditional Medicare plan, the health care law will not take away any of the benefits you already have. In fact, the law will offer you more benefits and cost savings.

Am I still able to see my doctor?

You can continue to see your doctor. If your doctor accepts Medicare, you can still see him or her.

Do I have to pay for preventive care?

No.  Medicare patients won’t have to pay for preventive services that Medicare currently offers. Preventive services help you stay healthy. The types of preventive services you need depend on your gender, age, medical history and family history. Examples of preventive services include diabetes screening, some vaccines (such as the flu shot), colorectal cancer screening, Pap smears for women and prostate cancer screening for men.

Medicare patients also get a free annual physical exam to assess their health risks.

How does the law benefit me if I have Medicare Part D?

The law benefits Medicare patients who hit the coverage gap (“donut hole”) under the prescription drug benefit. The coverage gap is a period of time in which you have to pay for all your prescription drug costs yourself.

  • If you are a Medicare patient, you will receive a 50% discount on brand-name prescription drugs covered by Medicare Part D. In addition, if you buy generic drugs covered by Medicare Part D, you will pay only 86% of the cost (a 14% discount).
  • Medicare Part D members will receive additional savings during the coverage gap over the next 7 years. The coverage gap will be eliminated by 2020.

How does the law affect Medicare Advantage plans?

When you enroll in Medicare, you will still be able to choose between Original Medicare and a Medicare Advantage plan. (For more information about Medicare coverage options, visit the Medicare website.)

Medicare Advantage plans have tended to offer extra benefits that seniors in traditional Medicare don’t get. However, the law will gradually cut spending on the Medicare Advantage program. This may mean that the Medicare Advantage plans may offer fewer benefits in the future. Changes to the Medicare Advantage plans are likely to occur gradually over the next few years.

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Written by familydoctor.org editorial staff

Reviewed/Updated: 02/14
Created: 07/10

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