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What Does Obamacare Mean for Medicare Beneficiaries?

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As the Affordable Care Act inches closer to full implementation, the health insurance landscape is changing rapidly. For beneficiaries of Medicare, things can get quickly confusing as they try to decipher what it all means. Contrary to some rumors, the new health law is not ending Medicare, but some things will change. Here's what to know about your Medicare coverage under the Affordable Care Act.

You don't need to worry about the health insurance marketplace
You don't have to log on to health or worry about switching plans. In fact, it's illegal for marketplace providers to sell you an insurance policy if they know you have Medicare. In most cases, your coverage is ACA-compliant and you won't have to lift a finger.

The exception may be if you have only Medicare Part B and no supplemental insurance. Part B on its own is not compliant with the health law, but if this applies to you, you can pay the tax penalty after the end of the year, or visit with your Medicare representative to see if a Medigap plan is right for you. This year the Obamacare penalty is $95 or 1% of your income, whichever is higher, so it may make more sense to keep the plan you've got.

You can keep your doctors, who will receive more support
Going forward, your doctors, hospitals, and care providers will have to coordinate your care. This means your coverage will be more consistent and secure -- you'll receive the right visits, exams, and services at the right time, no more and no less. This not only prevents the hassle of extra visits and takes you off the hook a bit for learning how to negotiate medical bills, but it helps prevents medical errors as well.

Doctors may receive support to implement the new tools -- like electronic health records and electronic prescribing software -- required to help coordinate care. Most notable of the new tools doctors (and you) will be using is Medicare's Blue Button. This is a program that lets you download all of your health information to your computer or smartphone and save it to share with your doctors. For more information or to look at your health records, go to and look for the blue button in the center of the page.

Medicare coverage will actually expand
You will not lose any coverage going forward, and in fact you will gain some. For instance, all the preventive care services required to be free for qualifying plans under the health law will also be included in Medicare. This includes mammograms, colonoscopies, daily aspirin, cholesterol screening, flu shots, and wellness visits -- services that are crucial to Medicare's primary coverage group: seniors.

The doughnut hole is closing
The doughnut hole refers to a coverage gap for some Medicare drug programs after the beneficiary has paid $2,800 out of pocket. Once this limit is reached, the beneficiary must pay full price for all drugs until $4,450 has been paid. The health law mandates that this gap be closed by 2020, and Medicare coverage for prescription drugs will increase each year until then.

Starting this year, if you find yourself in the doughnut hole, you'll pay 47.5% of cost for brand-name drugs and 72% for generic drugs. In 2015 those amounts shrink to 45% and 65%, respectively. Starting in 2020, the gap will be gone, and you'll pay 25% of all prescription drug costs, no matter what you've paid out of pocket.

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  • Report this Comment On April 22, 2014, at 7:39 PM, JonahB wrote:

    Some of the information in this article is not quite correct. If you don't have Medicare A and B, you cannot buy a Medigap policy. I don't know what a "Medicare representative" is. You can call 1-800 Medicare, but you can't go visit a "representative." You can contact a SHIP counselor (Senior Health Insurance Assistance Program) for free Medicare counseling. They can be found through your local Area Agency on Aging. I hope this helps.

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