Medicare and “The Affordable Care Act”


Does the Affordable Care Act Affect Your Medicare?

With most of the changes included in the Affordable Care Act officially starting in

2014, seniors often ask:

“How does this affect my Medicare coverage”?

This is a good question to ask, and an important one. Most things like the open

enrollment period (October 15th – December 7th) will stay the same. You won’t

need to do anything in regard to the new Marketplaces or Healthcare Exchanges.

Let’s look at some of the positive ways things have changed if you have Medicare

in 2014 and onward:

Preventative Care

You get more preventative services, for less money. You can have a free wellness

exam every year. You can also get most screenings free. Mammograms,

colonoscopies, checks for diabetes, and cholesterol are covered at 100% in most


More Affordable Prescriptions

The donut hole is shrinking. The donut hole is a gap in your drug coverage under

Medicare Part D. Normally, each part D plan covers up to $2,850 for medicines

every year. Once you reach that limit, your prescription benefits go down. That’s

when you are in the gap or “Donut Hole”.

When in the donut hole, your copay for medicine rises to 47.5% for brand-name

prescriptions and 72% for generics. You pay this until you’ve spent $4,550. The

good news is that in time, the donut hole will go away. Each year from now until

2020, the percentage you pay during this gap in coverage will go down. In 2020,

the gap will be gone. You will pay 25% for all prescriptions in 2020 regardless of

whether they are brand or generic drugs.

Protection of Medicare for Years to Come

According to Medicare.gov: “The life of the Medicare Trust fund will be extended

to at least 2029—a 12-year extension due to reductions in waste, fraud and

abuse, and Medicare costs, which will provide you with future savings on your

premiums and coinsurance.”