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Medicare and the Affordable Care Act

Steven Mott by Steven Mott | Licensed since 2012
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This article was updated on: 02/23/2016

The Affordable Care Act (ACA), also known as Obamacare, has had an impact on the Medicare program.

Early-detection cancer screenings, such as mammograms and colonoscopies, are now covered under Medicare Part B with no out-of-pocket charges if your doctor accepts assignment. There’s also a yearly “wellness” visit to a physician that is free for Medicare beneficiaries, thanks to the ACA.

The ACA also seeks to close the prescription drug coverage gap (also called the “donut hole”). In the next several years, out-of-pocket costs for drugs are expected to drop, and the coverage gap will close in 2020.

In addition, improved coordination between doctors, hospitals, and insurance companies as mandated by the ACA will ensure that patient information is shared more efficiently to improve care and minimize errors.

Obamacare impact on Medicare Advantage plans

If you are currently enrolled in Medicare, you do not need to enroll in another health plan with the Health Insurance Marketplace, and your Medicare coverage will not be affected by this part of Obamacare. In fact, it’s prohibited for someone to sell you a Marketplace health plan if they know you have Medicare. If you decide to make changes to your Medicare coverage, you will do so during the Medicare Annual Election Period (from October 15 to December 7), not through the Marketplace.

If you have Original Medicare (Part A and Part B), Medicare Part A only, or a Medicare Advantage plan, you meet the Affordable Care Act requirement to have health insurance. However, if you are only enrolled in Medicare Part B, this does not satisfy Obamacare’s minimum essential coverage requirement. You may need to purchase a Medigap policy to supplement your coverage, or you may face a tax penalty.

Do your research:

  • If you are already a Medicare beneficiary, then you do not need to sign up for health coverage under the health-insurance marketplace at Healthcare.gov.
  • Medicare is not part of the ACA marketplace, and the eligibility rules for your health and prescription drug coverage remains the same.
  • Once your Annual Notice of Change arrives in the mail, review it to be sure that your health needs fit what’s included in your Medicare plan so that you aren’t facing out-of-pocket costs in the future.
  • Remember to shop around if you’re thinking about changing your Medicare plan options in the future.

If you’re thinking of updating your Medicare coverage, the Medicare Annual Election Period is a good time to do so, and I can help. Learn more about me by clicking on the “View profile” link below. You can schedule a phone appointment or have me email you personalized Medicare information, just use the links below. To take a closer look at plans now, click on the Compare Plans buttons on this page. Feel free to call me or another eHealth licensed insurance agent at the contact info below.

Call Medicare.com’s licensed insurance agents at 1-844-847-2659, TTY users 711; Monday through Friday, 8AM to 8PM ET.

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