The health care reform law (the Affordable Care Act) has been implementing reforms aimed at making Medicare more solvent and more valuable to beneficiaries since 2010. How has that affected Medicare beneficiaries?
Free Preventive Health Care
One of the changes in original Medicare is that many preventive health care services are available with no out-of-pocket costs now. New enrollees are entitled to a free physical exam. In later years, slightly less thorough wellness exams continue with no out-of-pocket costs, as long as the services are billed as preventive rather than diagnostic. Of course, doctors who do not accept Medicare payments are not participating by offering
these exams as free services.
About one-quarter of Medicare beneficiaries are enrolled in Medicare Advantage plans. These plans are subsidized by the federal government, but are offered by private health insurance companies. Most of them provide coverage for prescriptions just like Part D prescription drug plans. Both types of drug coverage have been significantly enhanced by the discounts on brand-name and generic drugs, along with a $250 check that’s already been issued to beneficiaries to help with the high cost of prescriptions.
If you’re already enrolled in Medicare, you still have the option of adding a Part D plan or switching from original Medicare to a Medicare Advantage plans each year from October 15 through December 7. Just check the plan’s formulary list to see whether your medication is covered and what your out-of-pocket costs will be if it is before you apply.
With either an Advantage plan or a Part D plan, once you reach the “donut” hole coverage gap, you’ll have to pay for your medication. Health care reform helps out with discounts on prescriptions, and is on track to eliminate the gap completely in a few years. Health care reform gives a 50-percent discount on brand-name drugs and a seven-percent discount on the less expensive generic drugs.
Right now, when you hit the “donut” hole, it automatically resets at the beginning of the next year so your prescription coverage begins at full strength.
Jim McFadden has over 11 years of executive-level experience in the health insurance industry, is a youth baseball, softball and football coach, and has one of the worst fantasy football records in the world.