Medicare And The Donut Hole Problem
If youre currently enrolled in Medicare, then youve probably heard the term more than a few times. Over the last few decades, the Medicare donut hole has grown into a serious problem that Obamacare attempts to correct through better spending and the elimination of fraudulent practices. What is the donut hole? The term donut hole refers to the gap that happens when Medicare Part D beneficiaries reach the end of their prescription drug coverage limits but havent met the spending limits for the year. During the gap, beneficiaries must pay full price for their prescriptions, and these costs can add up to substantial sums if beneficiaries spend a lot of time in the gap. Lets look at an example of the donut hole at work.
The Affordable Care Act seeks to rectify the coverage gap situation by closing the Medicare Part D donut hole completely by 2020. By reducing the amount that seniors pay during the gap and eliminating other wasteful spending throughout Medicare, lawmakers hope to close the donut hole for good. If accomplished, this would mean that seniors and other Medicare beneficiaries would receive the drugs they need at affordable prices. The donut hole causes a lot of problems for the elderly in particular because many Medicare beneficiaries are retired or dont work due to disability. With limited income, coverage gaps impose harsh restrictions on the care that some people can receive.
Women Can No Longer Be Charged More For Insurance And Are Guaranteed Coverage For Services Essential To Womens Health
Prior to the ACA, women faced unique barriers to adequate care. Insurers in the individual market could charge women up to 1.5 times more than men for health insurance, a discriminatory practice known as gender rating, and insurers treated pregnancy as a preexisting condition. Plans could also exclude critical womens health benefits from coverage: In 2011, 62 percent of individual market enrollees were in plans without maternity coverage. The ACA outlawed gender rating and prohibited insurers from discriminating against people with preexisting conditions. The latter is a crucial protection for women: About 1 in 2 girls and nonelderly women have a preexisting condition.
Thanks to the ACA, about 61 million women nationwide can access contraception without any out-of-pocket cost.
The ACA mandates that plans include maternity coverage and makes key preventive services available without cost sharing, including breastfeeding support services and supplies annual well-woman visits and screenings for cervical cancer, HIV, and interpersonal and domestic violence. Thanks to the ACA, about 61 million women nationwide can access contraception without any out-of-pocket cost. One study estimated that the ACAs contraception benefit has saved women at least $1.4 billion annually on birth control pills alone.
The Minimum Essential Coverage Requirement
Does Medicare coverage count toward the Affordable Care Acts minimum essential coverage requirement? You may have some questions regarding minimum essential coverage, and we want to help you understand what this requirement means so that you can make a more informed decision about your healthcare coverage. Under the ACA, all health insurance plans must provide for certain protections and rights. All plans on the federal and state marketplaces as well as most employer-based plans already comply with the law, but some people have questioned whether Medicare meets the requirement or not. The short answer is that most Medicare plans meet the requirement for minimum essential coverage.What benefits are included in the requirements? Minimum essential coverage applies to all healthcare plans including Medicare. Here are the ten essential benefits that all plans must offer regardless of insurance provider:
- Ambulatory services like outpatient care
- Emergency services
- Maternity care during and post-pregnancy
- Mental health services
- Preventative care like annual health screenings
- Rehabilitative services and devices
- Surgery and hospitalization
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Young Adults And The Affordable Care Act: Protecting Young Adults And Eliminating Burdens On Families And Businesses
The Affordable Care Act allows young adults to stay on their parents health care plan until age 26. Before the President signed this landmark Act into law, many health plans and issuers could and did in fact remove young adults from their parents policies because of their age, leaving many college graduates and others with no insurance. This helps to explain problems like
- Young adults have the highest rate of uninsured of any age group. About 30% of young adults are uninsured, representing more than one in five of the uninsured. This rate is higher than any other age group, and is three times higher than the uninsured rate among children.
- Young adults have the lowest rate of access to employer-based insurance. As young adults transition into the job market, they often have entry-level jobs, part-time jobs, or jobs in small businesses, and other employment that typically comes without employer-sponsored health insurance. The uninsured rate among employed young adults is one-third higher than older employed adults.
- Young adults health and finances are at risk. Contrary to the myth that young people dont need health insurance, one in six young adults has a chronic illness like cancer, diabetes or asthma. Nearly half of uninsured young adults report problems paying medical bills.
Providing Relief for Young Adults
Access to Insurance: What Young Adults and Parents Need to Do:
New Tax Benefits for Adult Child Coverage
Key elements include:
Coventry Healthcare, Inc.
Medicaid Expansion Is A Good Deal For States
Another unanticipated swerve along the path to implementation took place in 2012, when the Supreme Court ruled that the federal government could not require states to expand Medicaid. The ruling thus left expansion up to the states. In the wake of this decision, roughly half of the states have expanded Medicaid and half have not.
RAND analysis found that Medicaid expansion is a boon for states: it boosts state economies and benefits the poorest residents by expanding their access to coverage and care and reducing their health spending and exposure to catastrophic medical costs.
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What Is Medicare And When Do I Need It
Medicare is described as a social insurance program, meaning in practice that its primary financing is obtained by a tax on all wages. About 2.9% of a persons income will go towards this program via the payroll tax, and all legal U.S. citizens are entitled to the benefits after reaching the age of 65. Certain disabled persons qualifying for SSDI may also be covered. In this way the risk is spread across a diversity of the population.
The benefits under Medicare are divided into parts A through D. Part A is used for hospital visits, while Part B is for Doctors visits. Anyone using Medicare for a hospital stay must show improvement, however, and this is usually where the most confusion between Medicare and Medicaid occurs.
The situation is usually a variation of the following: An elderly person falls and breaks a bone, and goes to the hospital for emergency treatment. After being treated, the hospital retains the patient until her condition is stabilized. The patient is then moved to a rehabilitation facility, many times a place that also treats persons for long term care. During the patients stay, several therapists work with her to improve mobility and other activities of daily living until the patient is capable enough to return home.
Biden Reconciliation Framework Includes Medicaid Workaround No Medicare Dental Or Vision Benefits
The White House-backed social spending framework will feature a pared-down expansion of both Medicare and Medicaid coverage as President BidenJoe BidenBiden to meet House Dems before Europe trip: report21 House Democrats call for removing IRS bank reporting proposal from spending billOvernight Health Care Presented by Altria Vulnerable House Dems push drug pricing planMORE seeks to secure enough support to advance the legislation.
The framework, previewed for reporters Thursday morning ahead of Biden’s meeting with House Democrats, would offer four years of subsidized private health insurance on the Affordable Care Act exchanges for people with lower incomes living in states that did not expand Medicaid under the health care law.
According to the White House, the plan would provide $0 premiums for 4 million people in the “coverage gap,” meaning they don’t earn enough to qualify for ACA subsidies but, since they live in a nonexpansion state, also make too much to qualify for Medicaid.
The temporary plan is more industry-friendly than the proposal offered by House Democrats in September, which would have created an entirely new “Medicaid-like” government program to provide coverage in the 12 nonexpansion states.
But at the same time, the temporary plan could be easier to set up and may avoid pushback from industry groups that worry a new federal program is a stepping stone to a larger-scale, government-run public option.
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Q: I Have A Marketplace Plan On My Own How Do I Go About Switching From That Plan To Medicare
A: If you sign up for Medicare during the first three months of your IEP, your coverage will begin on the first day of the fourth month. To enroll, call Social Security at 800-772-1213 and schedule an appointment at your local Social Security office. Alternatively, you can sign up online on Social Security’s website .
However, if you already receive Social Security benefits, the Social Security Administration will automatically sign you up for Medicare Part A and Part B and send your Medicare identity card by mail. The agency will specify the date when coverage becomes effective, without your having to actively enroll.
When you know the date on which your Medicare coverage is due to begin, you can cancel your Marketplace coverage. For example, if Medicare will begin May 1, you will want your Marketplace coverage to end April 30. To make this transition, it’s important to cancel your Marketplace policy at least 15 days before you want the coverage to end and to specify that you want it terminated on the final day of the month.
A word of caution: If you delay Medicare enrollment until the fifth, sixth or seventh month of your IEP, the beginning of your coverage will be delayed by two or three months. For example, if September is the last month of your IEP and you sign up anytime in that month, coverage would be delayed three months and begin on Dec. 1. This is important to remember while calculating when you want your Marketplace coverage to end.
Medicare Funding And Cost Distribution
Before we go over the changes to Medicare, well take a brief look at Medicare as it exists right now in the United States. For starters, you might be interested in knowing how Medicare gets funded and who operates the program. The U.S. Department of Health and Human Services operates the Centers for Medicare & Medicaid Services or CMS, which is the branch that manages Medicare and oversees Medicaid programs throughout the country. Medicare is funded through two trust funds managed under the direction of the U.S. Treasury: the Hospital Insurance Trust Fund and the Supplementary Medical Insurance Trust Fund. Each fund covers different aspects of Medicare, and both generate funding through taxes, Congressional budgeting and accrued interest.
Over the years, Medicare spending has increased to the point that the program no longer helps as many people as it could with the amount of money it supposedly generates. In other words, Medicare has become inflated due to administrative costs and other expenses that render it virtually ineffective to its enrollees. Obamacare addresses this cost discrepancy by establishing a plan to cut Medicare spending by $716 billion dollars over the next decade. By cutting costs to Medicare in the short-term, lawmakers hope to balance out the effectiveness of Medicare in the long-term. A balanced Medicare spending plan ensures that senior citizens and others who are eligible for the program receive maximum benefits.
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People Who Could Lose Their Health Insurance
Of the 23 million people who either buy health insurance through the marketplaces set up by the law or receive coverage through the expansion of Medicaid , about 21 million are at serious risk of becoming uninsured if Obamacare is struck down. That includes more than nine million who receive federal subsidies.
On average, the subsidies cover $492 of a $576 monthly premium this year, according to a report from the Department of Health and Human Services. If the marketplaces and subsidies go away, a comprehensive health plan would become unaffordable for most of those people and many of them would become uninsured.
States could not possibly replace the full amount of federal subsidies with state funds.
Aca Medicare Insurance Premiums For Seniors
The ACA doesnt raise premiums for seniors. The AARP has predicted that it could hold the costs of Medicare Part B premiums down, if not lower them. The official formula for determining Medicare Part B premiums was established by Congress years ago and has not been negatively affected by the ACA .
Despite the fact that ObamaCare does not affect seniors premiums, premiums for high-income seniors who earn more than $85,000 or couples with incomes over $170,000 will rise, as they would have done with or without the ACA .
If you have heard any talking points on how Medicare costs are negatively impacted by the Affordable Care Act you can find them debunked here and here.
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The Aca Lowered Costs For Seniors On Medicare
Altogether, ACA programs have saved seniors more than $20 billion on prescription drugs since the laws passage, and seniors have benefited from no-cost preventive services such as cancer screenings and wellness visits. By closing the Medicare Part D coverage gapalso known as the donut holethe ACA has helped lower beneficiaries out-of-pocket costs for prescription drugs. Prior to the ACA, seniors who reached a certain level of prescription drug spending faced a coverage gap, in which they had to pay the full cost of all prescription drugs, before the plans catastrophic coverage kicked in. Before the ACA closed the coverage gap, about 5 million Medicare enrollees fell into it.
The ACA also invested in other improvements for the Medicare program by establishing the Center for Medicare and Medicaid Innovation, which is responsible for developing ways to improve patient care and lower health care costs.
The Aca And Medicare Costs For High
The formula for Medicare part B is unaffected by the ACA and most seniors wont see a rise in the prices they pay. However, Medicare recipients with higher incomes have historically paid more for their Part B coverage, which is the medical insurance portion of the program and helps pay for outpatient medical care such as doctor visits, lab tests, and durable medical equipment. High-income seniors may still continue to pay higher rates despite the changes to Medicare.
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Apply For Aca Get Medicaid
You may not know you’re eligible for Medicaid until you fill out an application for health insurance through the ACA-created health insurance exchange in your state.
If the exchange determines that you qualify for Medicaid, it will forward that information to the state Medicaid office, which starts the Medicaid application process.
Since you submitted your initial health insurance application to an Obamacare health insurance exchange, it might surprise you to end up receiving Medicaid instead of a private Obamacare plan. However, this is a normal part of the process.
Ways The Aca Has Improved Health Care In The Past Decade
The health care law provides coverage for millions of Americans and protects people with preexisting conditions, but it remains under threat from a Trump administration-backed lawsuit.
Ten years ago this month, the Affordable Care Act was signed into law. Since then, the law has transformed the American health care system by expanding health coverage to 20 million Americans and saving thousands of lives. The ACA codified protections for people with preexisting conditions and eliminated patient cost sharing for high-value preventive services. And the law goes beyond coverage, requiring employers to provide breastfeeding mothers with breaks at work, making calorie counts more widely available in restaurants, and creating the Prevention and Public Health Fund, which helps the Centers for Disease Control and Prevention and state agencies detect and respond to health threats such as COVID-19.
The consequences of ACA repeal would be dire:
As the nation awaits a final ruling on the lawsuit, the Center for American Progress is celebrating how the ACA has helped the American people access affordable health care in the past decade. In honor of the laws 10th anniversary, here are 10 ways in which it has changed Americans lives for the better. Each of these gains remains at risk as long as the Trump administration-backed lawsuit remains unresolved.
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What Is Masshealth And What Are The Benefits
MassHealth is basically the consumer branch of the Massachusetts Department of Health and Human Services. In the words of its mission statement, MassHealth provides comprehensive health insurance or help in paying for private health insuranceto more than one million Massachusetts children, families, seniors, and people with disabilities. In addition, MassHealth is the second largest insurer in the state. However this description of MassHealth sounds, the truth is that the question has no easy answer, since benefits and services under MassHealth are often changing with rising costs and changing client needs.
This system was used as a model for the nationwide healthcare plan known also as the Patient Protection and Affordable Care Act or Obamacare. In that sense it is a system that covers all insured persons within the state.
Q: I Am Enrolled In Medicare Part A But I Missed My Deadline For Signing Up For Part B And I’m Now Looking At Many Months Without Coverage Can I Enroll In A Marketplace Plan To Help Pay My Medical Costs Until Part B Kicks In Next July
A: The answer, unfortunately, is no. People miss their Part B enrollment deadline for many reasons most often because, in the absence of any official notification about Medicare enrollment for everyone approaching age 65, they were given wrong information when consulting friends, employers, insurance companies or even, in some instances, government officials. Whatever the reason, the consequence is the same: Under Medicare rules, they are allowed to enroll only during a general enrollment period, which runs from Jan. 1 to March 31 each year, with coverage not beginning until July 1 of the same year.
Under Marketplace rules, anybody who has Medicare Part A alone, without paying a premium for it, is considered to have creditable health coverage, thus protecting them from having to pay Marketplace penalties for noncoverage. But Marketplace rules also insist that insurance companies cannot sell a Marketplace plan to anyone who is enrolled in any part of Medicare, because that would violate the law that protects consumers from being sold insurance that duplicates Medicare benefits.
This really hits people who have Part A but not Part B because, of course, it is Part B that provides coverage for the doctors’ and outpatient services that comprise most people’s everyday health care needs. And for people over 65, it is also virtually impossible to buy coverage in the open insurance market, outside of Obamacare.
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