Bringing Affordability to Aging

Last Thursday, June 28th, 2012, the Roberts court ruled 5-4 to uphold the Affordable Care Act (ACA), the 2010 health care reform legislation that brings health insurance to another 30 million Americans.

While the legality of the legislation was challenged on the constitutionality of the individual mandate, most health care analysts are beginning to answer the what now? questions arising from the American public. This post seeks to highlight five very important provisions for older adults under the ACA.

1. Annual Wellness Visits

Under the ACA, seniors are entitled to an annual wellness exam with no out-of-pocket costs to the patient. Megan Golles highlighted to importance of proper nutrition for older adults in her recent blog post. On this note, wellness visits aim to promote healthy habits and disease prevention among Medicare beneficiaries. It is also a source of care coordination during which the provider established a list of up-to-date providers for a patient. In 2011, over 2 million Medicare recipients took advantage of their free exam.

2. Preventative Services

Many preventative services are also now covered free of charge under the ACA. Services include: mammograms, immunizations, pap smears, bone density scans, diabetes and depression screenings with no additional expenses to seniors. This portion of the Act was actually implemented in 2010, but the Supreme Court decision confirms that it won’t be overturned. According to AARP, over 32 million used a free preventative service in 2011.

3. Closing the Donut Hole

By 2020, the ACA will completely close the prescription drug donut hole – the gap in coverage that exists for Medicare Part D beneficiaries. Who’s footing the bill? Under the ACA, pharmaceutical companies will be paying a 50 percent rebate and the government will pick up 25 percent of the cost on all brand name drugs. For generics, the government will pay 75 percent by 2020. An interesting perspective on curbing drug costs can be found on the Psychology Today blog. Under the new health care law, Seniors will still have to pay a quarter of their prescription drug costs but it’s a whole lot better than paying full price. According to AARP, 5.3 million Americans have saved, on average, over $600 dollars since the law was enacted.

4. Home and Community Based Services

Arlene Wanetick highlighted how older adults are taking control of the end of life, so it only follows that they should also have a say in their long term care environment. To this end, two billion dollars have already been set aside in the ACA for programs that think outside the nursing home model. The ACA encourages more person-centered long term care demonstration projects such as the Community First Choice, Balancing Incentives Payment Program, Money Follows the Person and State Plan HCBS. In Illinois, a time-specific demonstration project for Money Follows the Person is already underway. Their website provides a detailed account of their current work.

5. Fraud and Abuse

Kate’s blog post raised awareness for financial exploitation among older adults. According to the Government Accountability Office (GAO), Medicare is the leading federal program plagued by fraud, with estimates putting fraud at $60 million dollars a year.. Currently, the ACA puts aside $350 million for oversight purposes through the Medicare Fraud and Abuse Control Program.

The above highlights reflect only some of the new legislation affecting older adults under the ACA. Moving forward, it’s important to stay informed on the types of benefits and changes the Affordable Care Act will bring to our aging population. As the Supreme Court’s ruling upholds substantial benefits to our Medicare and Medicaid beneficiaries, do your part and spread the word to others.

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