Healthcare Reform and Medicare: Navigating a Changing Landscape

The Affordable Care Act and Medicare Part D

Updated on: June 7, 2018

Originally posted on: September 2, 2014
Former Vice President of Medicare Solutions Ms. Rabbitt specializes in helping seniors better understand the complexities of Medicare coverage. Topics include transitioning to Medicare and the appeals process.

Confused about how healthcare reform will impact your Medicare coverage? You’re not alone. According to our 2013 survey, many retirees have misconceptions about reform and Medicare. These misconceptions could lead to low Medicare enrollment and poor health decisions.

To help clear up the confusion, here are several facts you need to know.

What Healthcare Reform Has NOT Changed:

  • The Medicare eligibility age has NOT changed. Seniors still become eligible for Medicare at age 65.
  • Public Health Insurance Exchanges are NOT replacing Medicare
  • The enrollment process for Medicare health and prescription drug (Parts A, B and D) benefits has NOT changed

Healthcare Reform Helps Lower Your Prescription Costs

Many seniors believe that healthcare reform is increasing their prescription costs. In fact, the opposite is true. Healthcare reform helps lower your prescription drug costs, as well as some medical expenses.

Here’s how:

  • The Coverage Gap (also known as the “donut hole”) is closing
    • In a standard Medicare Part D plan, the Coverage Gap, also known as the “donut hole,” is the stage of coverage where you pay a higher percentage of the cost of prescription drugs. In 2015, you enter the Coverage Gap once your Part D drug expenses (what you pay in your deductible and copayments plus what the plan pays) exceed $2,960. At that point, you will pay 45% of the cost of covered brand-name drugs and 65% of the cost of covered generic drugs. If your out-of-pocket costs reach $4,700 in this stage, you will move into the last stage of coverage, known as the Catastrophic Coverage stage.As part of the Affordable Care Act, the Coverage Gap stage is being phased out and will be eliminated completely by 2020.
  • Under healthcare reform, many preventative screenings are now fully covered by your Part B plan, including:
    • Bone mass measurements
    • Screenings for diabetes
    • Cancer screenings such as mammograms, prostate exams, Pap tests and pelvic exams
    • Flu, hepatitis B and pneumonia vaccines
  • Medicare Part D will cover vaccines necessary to prevent illness, such as meningitis and pertussis, which are not available under Parts A or B

Understanding the impact of healthcare reform on Medicare Part D is the first step in taking advantage of its benefits. Not only will you now have access to more services and screenings, but you’ll also save money.