By Sandy Longobardy, Medicare Education Specialist
MemorialCare Medical Group
With the recent implementation of the Affordable Care Act and Covered California, older adults may have questions about changes in health coverage concerning their current Medicare plan. Certain things are “staying the same,” like choosing your own doctor, but there are certain changes that will affect most older adults with Medicare coverage.
The Medicare Trust Fund has been extended through the year 2029, and many of the benefits to Medicare have remained the same for now. Due to the new structure of the healthcare system, there are some changes for Medicare Advantage plans and for hospital care that could affect benefits and costs.
Preventative healthcare changes for staying healthy
One of the best ways [for] older adults [to be sure they are] staying healthy is [for them to visit] their physician regularly for preventative care appointments. Under the new Medicare guidelines, a lot of preventive care is now free, such as an annual wellness exam.
Screenings are medical tests to find illnesses early, when they’re easier to treat. Most screenings, like mammograms and colonoscopies, are free. Older adults also can be checked for diabetes, high blood pressure and high cholesterol.
Some older adults may have access to certain prevention programs, like a smoking-cessation program.
Patching up the gaping doughnut hole
Most Medicare prescription drug plans have a coverage gap (also called “the doughnut hole”). This is a temporary limit on what the plan will cover for medications. While in the gap, older adults are required to pay for prescription drugs until their plan goes back into effect.
The doughnut hole is now shrinking. Each year from now until 2020, the percentage paid during this gap in coverage will go down. Effective immediately, the copay for medicines is 47.5 percent for brand-name prescriptions and 79 percent for generics.
In 2020, the doughnut hole will be completely gone, and older adults will pay 25 percent for all prescriptions, generic or name-brand.
Medicare changes benefiting patient and physician
Due to the changes in Medicare, there’s an added incentive for separate medical groups to work together. Physicians can be rewarded, either in the form of a financial bonus or a larger fee from programs like Medicare, for giving their patients quality care.
In order to provide effective primary care, physicians and specialists will work together to increase the continuum of care. This is good for older adults because it means that all of their doctors have to work together in order to earn this extra money, regardless of their medical group.
There are more changes coming in the near future, and it’s important to remember that Medicare doesn’t cover the total cost of health care. In order to create a plan that works for older adults, they must educate themselves about additional insurance, such as Medicare Advantage Plans or a Medicare Supplement, to make sure that they’re provided with the coverage they need.
The MemorialCare Senior Plus Program at Long Beach Memorial and Community Hospital Long Beach hosts a lecture every other month for older adults to learn about original Medicare, Medicare Advantage, prescription drug plans and Medigap plans. The next “Medicare 101” lecture is on Tuesday, Aug. 12. Call (866) 363-6511 to register.