Everything you Need to Know about Medicare and the ACA

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medicare_logoWith about 11,000 baby boomers becoming eligible for Medicare every day combined with the gradual implementation of the new Affordable Healthcare Act (ACA), it comes as no surprise that I have been getting a lot of questions lately from boomers who are concerned about their Medicare benefits.[i]

Will the ACA Cut Medicare Benefits for Seniors?

The good news is that the Affordable Healthcare Act does not negatively affect Medicare coverage.  Once you turn 65, you automatically qualify to receive Medicare benefits, which include prescription drug coverage, free preventative care, yearly wellness screenings, and low deductibles.  If you want to learn more about the specific details of Medicare coverage, you can visit the official Medicare site.

Changes to Medicare under the ACA

While the Affordable Healthcare Act does not cut benefits to seniors, it does introduce some changes that are meant to prevent fraud and decrease the cost of running Medicare.  One of prescription bottlethe most significant improvements involves closing the “donut hole” in prescription drug coverage.  Here is how the system used to run:

  • “Medicare recipients were responsible for 100% of drugs costs until they reached the $310 deductible amount.
  • Once patients hit that deductible amount, they only had to pay 25% of drug costs until the total cost reached $2,800.
  • At that point, there was a gap in coverage and patients once again became responsible for 100% of drug costs until their total spending for the year reached $4,550.  This gap became known as the “donut hole.”
  • After the yearly spending limit was reached, Medicare subscribers only had to pay a small percentage of drug costs.[ii]

 

Not only was this coverage program confusing, it placed a huge financial burden on seniors who found themselves in the donut hole and struggling to pay for prescription drugs.  Seniors often resorted to skipping doses, splitting pills, or completely giving up on taking some of their more expensive medications.  The ACA was designed to gradually close the coverage gap and make ensure that seniors are able to afford necessary medications.  The ultimate goal is for Medicare recipients to pay 25% of the cost of prescription drugs up until they reach the $4,550 threshold.  After that point, they will receive additional assistance.”[iii]

Does Medicare Cover the Cost of Mobility and Disability Equipment?

mobility scooterThe short answer:  probably not.  In order to qualify for reimbursement, your equipment must be deemed as absolutely necessary by both a doctor and Medicare.  This means that you will not get assistance paying for your wheelchair, walker, or lift chair unless you are unable to function without that piece of equipment.  For example, Medicare will not help cover the cost of a mobility scooter if there is the possibility that you could use a less expensive walker to get around.

Another downside of looking to Medicare to help finance your medical equipment is that it often takes months before you receive a check.  For some customers who have experienced a sudden loss of mobility or are facing a major surgery, they simply can’t wait months to get the equipment they need.

Conclusion

While the ACA does provide some improvements to the Medicare system, it may still be difficult for those with mobility challenges to get the equipment they need.  The best advice is to plan ahead.  If you are in good health now, it may be hard to plan for worst case scenarios, but a little bit of foresight now can pay off big in the future.  Start by researching aging in place and getting a feel for the types of tools and solutions that are available on the market.  Often times, even the small modifications to your home can make a huge difference in improving your safety and mobility.  Learn what you can do now to get the most out of your golden years.  Here are some excellent sites that kick-start your planning process and provide some inspiration:

Nation Association of Home BuildersNAHB-Logo

Changing Aging

National Aging in Place Council

Have more questions about Medicare, the Affordable Health Care Act, aging in place, or any other topic?  Send me your questions and concerns!

[i] Hunter, Melanie.  “Senior Boom: 11,000 New Seniors Become Eligible for Medical – Every Day.”  CNSNews.com, 11 June 2012.  Web. 5 November 2013.

[ii] Blum, Jonathan.  “What is the Donut Hole?”  HealthCare.gov, 9 August 2012.  Web. 4 April 2013.

[iii]Seniors and the Affordable Health Care Act.”  AmeriGlide, 5 November 2013.  Web. 5 November 2013.

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