How the Health Care Law Affects Your Medicare Benefits

I am a Medicare beneficiary. How will the law affect me?

The health care law overhauls the entire health care system. If you’re a Medicare beneficiary, it’s important for you to know that the Health Care Law doesn’t cut or eliminate any of your Medicare benefits. In fact, the law enhances your benefits in several key areas, and it establishes a new Centers for Medicare & Medicaid Innovation to find new methods of improving services, outcomes, costs, and more.

Changes to Medicare with the Health Care Law

Since 2010, there have been changes to Medicare, and Health Care Reform will continue these changes in 2014. Here are some of the ways the Health Care Law affects your Medicare coverage:

The “donut hole”

The law shrinks and eventually eliminates the coverage gap known as the donut hole for Medicare and Medicare Advantage beneficiaries enrolled in Medicare Part D prescription drug plans. This coverage gap occurred during the period of time when Part D medication costs for a person enrolled in a Medicare Part D prescription plan in a specific calendar year go over $2,830; it continued in that same specific calendar year until your out-of-pocket costs reached $4,550.

The cost of drugs acquired in a Medicare Part D prescription plan was the responsibility of the beneficiary while in the donut hole. Once out of the donut hole, Medicare picked up the remainder of the prescription drug costs for the rest of that specific calendar year.

As part of the Health Care Law, significant savings have been introduced to lower your costs. If you do not receive Medicare Extra Help, your medications are now discounted by these amounts when you are in the donut hole:

  • Brand-name and biologic drugs — 52.5 percent
  • Generic drugs — 21 percent

Over the next few years, additional discounts will further reduce the amount you will pay in the coverage gap, or donut hole. By 2020, the donut hole will be eliminated; you will then pay 25 percent of the cost of all your prescription drugs, no matter when you purchase them.

The amount of money this provision of the Health Care Law saves you increases each year. By 2020, the average amount you will save will reach $3,000 per year.

Preventive care

The Health Care Law makes preventives services more affordable. If you have Medicare, you no longer have to pay any cost-sharing fees, such as copays, for most preventive services. That means you do not pay for routine physical exams, certain cancer screenings (such as breast, prostate, cervical, and colon cancer screenings), bone mass measurements, and more.

Changes to Medicare Advantage with Health Care Reform

Some provisions in the Health Care Law affect Medicare Advantage (MA), a type of health plan offered by private companies like Independence Blue Cross that contract with Medicare. Here are some of the changes that affect MA:

  • The enrollment period for MA (with or without Part D prescription drug coverage) or a stand-alone Part D plan changed under the Health Care Law. Now you can only enroll in these plans each year during the six-week annual election period (AEP) from October 15 through December 7. That means you may no longer switch plans during the annual open enrollment period (January 1 through March 31).
  • The Health Care Law reduces funding to MA plans. This could eventually affect the benefits and number of plans available.
  • Centers for Medicare & Medicaid Services (CMS) established new maximum out-of-pocket (MOOP) limits for Medicare Advantage HMO and PPO members. Once you reach this limit, you are not liable for any additional costs for services covered by Medicare Parts A and B for the remainder of the calendar year. Here are the current MOOP amounts:
    • HMO members: $6,700.
    • PPO members: $6,700 for in-network services, and $10,000 for in-network and out-of-network services combined.

The amount you pay in out-of-pocket costs for medical (Medicare Parts A and B) services, mental health services, and Part B drugs are applied to your MOOP. Part D drug costs do not count toward your MOOP.

Let us help

Independence Blue Cross has a full array of health plans, including Medicare Advantage and Medigap plans, to meet your health care needs. We also have a dedicated website to help you navigate the changing health care environment. Our site — www.ibxmedicare.com — will help you compare plan options, find a pharmacy, learn about Medicare, understand how the Health Care Law affects you, and more.