Affordable Care Act & Older Adults Presented By: Kristen Benevides, Sherry Tanaka, Malloree Ullrich, & Abraleen Keliinui

What is Medicare? Medicare is a federal health insurance program that provides health insurance for people: ➢ 65 or older ➢ Under 65 with certain disabilities ➢ At any age with End-Stage Renal Disease (ESRD)

The Different Parts of Medicare Medical Part A (Hospital Insurance): ✓ Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, & home health care. Medical Part B (Medical Insurance): ✓ Helps cover services from doctors & other healthcare providers, outpatient care, home health care, medical equipment, & some preventative services. Medical Part C (Medicare Advantage): ✓ Is run by Medicare approved private insurance programs, includes all benefits & services covered under Part A & Part B, many include extra benefits & services for an extra cost. Medicare Part D (Medicare Prescription Drug Coverage): ✓ Helps cover the cost of prescription drugs & may help lower prescription drug costs & help protect against higher costs in the future.

Medicare Coverage Choices

Medicare Benefits Expanded ❖ Older adults will save an estimated total of $5,000 ❖ Savings on lower drug costs ❖ Reduce health-care costs through preventive services

Preventive Services Prior to the Affordable Care Act: ❖ Medicare focused on treating chronic conditions and diseases. ❖ No focus on preventive services. ❖ Beneficiaries required to pay 20% of preventive services.

Preventive Services After the passing of the Affordable Care Act: ❖ The focus is to keep beneficiaries healthy ❖ Free screenings ❖ Eliminate barriers, reduce costs, save on out-of-pocket money ❖ For a list of free screenings visit the website.

Annual Wellness Visits Prior to the Affordable Care Act: ❖ Medicare covered a once in a lifetime “Welcome to Medicare” wellness visit. ❖ Only offered during the first 12 months of enrollment.

Annual Wellness Visits After the passing of the Affordable Care Act: ❖ Beneficiaries are entitled to Wellness Visits every year ❖ Covered benefit ❖ Providers and Beneficiaries work together to create a wellness plan.

Lower Medicare Part B Premiums ❖ Members pay premiums. ❖ More efficient; reduces overall health care costs. ❖ ACA prevents Part B premiums from rising each year. ❖ Current Medicare Part B premium is $104.90/month.

Lower-Cost Prescription Drugs ❖ Reduces prescription drug prices for seniors ❖ Closes the coverage gap or “donut hole” 20 ❖ Medicare beneficiaries who fall into the donut hole will automatically receive a discount, 52.5% on brand-name drugs and 28% on generic drugs ❖ ACA closes the coverage gap in 2020

Doughnut Hole Video I forgot who is doing “Lower-Cost Prescription Drugs”, but I found this video that can be shown as well. Retrieved from: medicare.php medicare.php

Improvements for Medicare Advantage (MA) Plan Members ❖ MA aka Part C plans are required to provide all benefits/coverage that Medicare Part B provides and may charge more for extra services (i.e. vision, dental, hearing, health & wellness, etc.). ❖ MA cannot charge more than Part B for specialized services (i.e. chemotherapy, dialysis), in order to avoid discrimination against beneficiaries with serious health conditions.

Improvements for Medicare Advantage (MA) Plan Members ❖ Under the Affordable Care Act, MA plans must spend at least 85% of revenue on medical services for plan members, instead of profits and marketing costs. ❖ The Affordable Care Act will gradually reduce payments to Medicare private insurance companies to bring them more in line with costs under Part B. ❖ High quality MA plans will receive extra bonus payments to encourage private plans to increase the quality of care they provide to members.

Medicare Fraud, Waste and Abuse ❖ New resources and tools to protect taxpayer dollars by preventing fraud in Medicare and Medicaid on the efforts of the Department of Health and Human Services and the Justice Department ❖ Tougher penalities for people who steal from Medicare & more law enforcement to identify criminals abusing the law and beneficiaries

Medicare Delivery System & Payment Reforms Centers for Medicare & Medicaid Services (CMS): ❖ Improve U.S. health care delivery system to make services more efficient and accessible for seniors. ❖ Programs designed specifically to deliver higher-quality care to seniors while minimizing Medicare spending. ❖ Promotes team-based care and quality performance. ❖ Aims to reduce recurring ER visits and hospital stays by coordinating care and services for discharged patients to age-in-place.

Medicare Delivery System & Payment Reforms ❖ Reform that will initiate billions of dollars in savings. ❖ Due to the implementation of the Affordable Care Act, provisions from the Medicare Hospital Insurance Trust Fund will save $8 billion within the next two years and $418 billion by ❖ ACA implementation rewards providers for quality of services, instead of the quantity of services delivered. ❖ The Medicare Hospital Insurance Trust Fund will be able to sustain itself for twelve more years, allowing more coverage for the emerging seniors.

Medicare Trivia! ❖ Question: What does Medicare Part A cover? ❖ Answer: Helps pay for inpatient hospital care, home health, hospice, and skilled nursing facility care. ❖ Question: What does Medicare Part B cover? ❖ Answer: Outpatient services, preventive screenings, lab, x-ray, tests, mental health services...etc ❖ Question: What is Medicare Part C? ❖ Answer: Medicare Advantage Plans ❖ Question: What does Medicare Part D cover? ❖ Answer: Prescription drugs.

Resources ● Centers for Medicare & Medicaid Services. (2014). Affordable Care Act and Medicare. Medicare.Gov: The official U.S. Government site for Medicare. Retrieved from affordable-care-act.html. ● Centers for Medicare & Medicaid Services. (2014). Affordable Care Act Update: Implementing Medicare Cost Savings. Medicare.Gov: The official U.S. Government site for Medicare. Retrieved from apps/docs/aca-update-implementing-medicare-costs-savings.pdf. ● HHS Press. (2014). Medicare’s delivery system reform initiatives achieve significant savings and quality improvements - off to a strong start. U.S. Department of Health and Human Services. Retrieved from ● National Committee to Preserve Social Security and Medicare. (2014). How the Affordable Care Act Helps Seniors. Retrieved from How-the-Affordable-Care-Act-Helps-Seniors. ● The Affordable Care Act: Before and After. ● Families USA. (2012). Understanding the Health Care Law, Fact Sheet. Retrieved from: ● AARP. (2010). Understanding Medicare, What you need to know. Retrieved from: