Health Care Reform and Medicare Recipients

Newswise — From the time presidential candidate Theodore Roosevelt first discussed health care reform in 1912, the topic has been a precedent-setting issue in the U.S. The 2010 passage of health care legislation is no different, but has many Americans in a quandary about how it will affect them. This is especially true of senior citizens.

Seniors, who generally are on fixed budgets and have increased medical needs, have a high stake in health care reform. But unfortunately, the rumors swirling about this topic are as sizeable as the 1,000 pages of legislation. George Sillup, Ph.D., associate professor of pharmaceutical marketing at Saint Joseph’s University in Philadelphia, offers clarification on the issues most relevant to this population.

Impact on Medicare — A Mixed Bag 
Beginning next year, annual wellness visits and certain preventive services such as cancer screenings, will be free of cost. Medicare beneficiaries will no longer have to pay deductibles and co-insurance for this kind of care. Eighteen months after enactment, the law says Medicare beneficiaries will have access to a comprehensive health risk assessment and a free personalized prevention plan.

Groups that advocate for seniors, including AARP and the Medicare Rights Center, say that there will be no cuts to Medicare coverage for seniors. Additionally, next year, the law provides a 10 percent bonus through Medicare to primary care doctors and general surgeons practicing where they are in short supply.

How will Medicare prescription-drug benefits change? — A Big Win for Seniors 

This year, there is a $250 rebate for Medicare Part D enrollees who fall into the “doughnut hole” of drug coverage. “That’s a big improvement,” according to Sillup, “because seniors previously covered under Part D received coverage for their prescriptions up to $2,830 a year, then the participant paid 25 percent of the cost and Medicare covered the remaining 75 percent.” Once their prescriptions exceeded $2,830, they fell into the doughnut hole, or hole of no coverage, until they spent another $3,610 for their medications.

What will happen to Medicare Advantage? — Higher Premiums 
Today, Medicare pays private insurers an average of 14 percent more than it spends to care for those enrolled in traditional Medicare. The overpayments help lower premiums and co-insurance costs, and provide extra benefits like vision and dental coverage, even gym memberships. The law would nearly eliminate the overpayments, saving $132 billion over the next decade.

For people currently enrolled in Medicare Advantage plans, premiums and benefits will remain the same through the end of the year according to the Centers for Medicare & Medicaid Services (CMS). But costs could increase and extras may be eliminated next year when payments to insurers are to be frozen at 2010 levels. The payments will start to drop in 2012, Premiums will likely increase next year as they did this year.