Looking ahead in 2017…. What’s in store for seniors

February 1, 2017

With all the talk of changes to/repeal of the ACA we need to look at how seniors may be affected.

First, let’s look at what the ACA does for seniors.
  • Insurers must provide free preventative care coverage to Medicare beneficiaries.
  • Prescription medication costs are reduced and the “doughnut hole” (a specific period where seniors are responsible for full cost of prescriptions) is to be eliminated by 2020. Prescription cost is capped at 50% for those people presently in the “doughnut hole”.
  • Insurers must provide coverage with if a person has a pre-existing condition
  • ACA has embedded programs that help reduce medical care costs for seniors by making doctors
    • More accountable,
    • participate in cost sharing
    • decrease hospital re-admissions
  • The Prevention and Public Health Fund created through ACA offers preventative care through the Falls Program and the Chronic Disease Self-Management Education program.
  • The ACA implemented programs to reduce Medicare fraud and waste.

ACA and Medicare are so entwined that repeal without careful thought to replacement could seriously weaken Medicare. So, what lies ahead?

If ACA is repealed without an adequate replacement,
  • The “Donut Hole” will reappear…. prescription drug costs will increase as coverage decreases.
  • Free preventative care will no longer be available.
  • Because of the cost savings due to the programs that reduce medical care costs as well as programs that educate senior about health management and preventing falls the costs of care will increase. Increase in costs of managing Medicare can jeopardize the life of the program.
Possible replacement programs being discussed are:
  • The “Empowering Patients First Act” which will offer a 401k-like plan where income-based subsidies would be replaced by age-based tax credits making the program more expensive for seniors. Those who have let their premiums lapse can be charged more by their insurer.
  • The “Patient Freedom Act” is a plan that will shift much of power to the states. States could opt to keep ACA if they wanted. This plan offers a Roth Health Savings Account, a high deductible health plan and a basic pharmacy plan. It is a market-based plan that, reportedly, does not touch Medicare.
  • The Obamacare Replacement Act offers an option to buy inexpensive health insurance, contribute unlimited funds to a Health Savings Account (HSA), buy insurance across state lines, protects those with pre-existing conditions and does not affect Medicare as it exists now.

All these proposals are in the planning stages and will be vetted by lawmakers before any one of them can be enacted. It appears that there is interest in maintaining some of the aspects of ACA, i.e. coverage regardless of pre-existing conditions and prohibition of discrimination. Two of the plans consider the importance of maintaining the Medicare Program. This is encouraging new for seniors. Stay tuned……















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