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? —
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.