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The Affordable Care Act: How it Will Impact Seniors

Alison Stanton | Oct 3, 2013, 2:06 p.m.

Supplements are available in a number of different forms of coverage that were standardized by the federal government many years ago, Leafman adds. These supplement forms use letter designations “A – N” and the plans do not vary from insurance company to company. This standardization makes it easier for consumers to shop plans on price, he says.

“Additionally, since between 10,000 and 11,000 people per day are aging into Medicare, a trend that will continue through the year 2029, more insurance companies continue to enter into the Medicare supplement marketplace,” Leafman says. “Demand for Medicare supplement plans is being further accelerated by the fact that many employers are dropping or increasing the cost of retiree medical benefits, forcing more consumers into Medicare.”

These factors have created healthy competition among insurance carriers and the beneficiaries of this competition are consumers, Leafman notes, adding that unlike health insurance plans for younger people, there are virtually no differences from insurance company to company in the area of claims payment practices for Medicare supplements. “This is a qualitative concern of consumers but it is largely unfounded because the insurance companies offering Medicare supplements agree with Medicare to automatically pay their portion of any claims that are approved by Medicare.”

Although Leafman says it is not too well known, “Traditional Medicare”, or non-PPO or HMO Medicare, also offers a no-cost initial wellness visit, including a basic vision test, within 12 months of enrolling in Medicare Part B. Thereafter, annual wellness visits are also covered at no cost.

“Medicare Advantage Plans (Medicare Part C, HMO/PPO plan) which are an alternative to Traditional Medicare, also cover preventive services, and in nearly all cases these services are also covered at no additional cost,” Leafman says, adding that these plans do use physician networks, and services must be provided by a network physician or medical facility.

Medicare Part C – Medicare Advantage Plans

Those who are in Medicare Advantage (Part C) plans, which are private insurance plans that expand on traditional government-provided Medicare, will likely face higher premiums and reduced benefits due to upcoming reductions in the funding provided by Medicare to these private plans, Weissman says.

In addition, he feels that dramatic cuts in general Medicare funding—more than $700 billion between 2013 and 2022—will impact reimbursements to physicians, clinics, hospitals, skilled nursing services, home health care providers and others. 

“This has caused both uncertainty and concern regarding the availability of adequate medical services for seniors as these cuts are implemented,” Weissman says, adding that as is the case with many aspects of the ACA, only time will tell.      

Although Leafman is aware of the speculation about increasing costs and/or decreasing benefits for Medicare Advantage plans as a consequence of the ACA, he feels there is little concrete evidence to validate these concerns.

“Today more than one out of four people on Medicare participate in a Medicare Advantage plan. Many of these plans are offered by the insurance companies for little to no monthly cost, largely because they are funded by Medicare,” he says. “Participants in these plans have chosen to accept the restrictions of a provider network, and possibly higher copayments for service, in return for little to no monthly cost of coverage.”

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