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Affordable Care Act and Medicare

Learn how the Affordable Care Act can lower your Medicare costs and improve your health with preventive services.

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If you’re a Medicare beneficiary, you won’t be able to buy health insurance from the Marketplace provided by the Affordable Care Act (ACA). But there are some ways the ACA — also known as Obamacare — can still help you out.  

Several ACA provisions help strengthen the Medicare program. Here are three ways Obamacare can help improve Medicare.

#1 Medicare Advantage Cost Savings

The ACA restructured Medicare Advantage (MA) payments so that the government cost of MA would more closely match the cost of Original Medicare. As a result, MA plans saw an increase in reimbursement rates. Over the last decade, enrollment in MA plans has grown 24% .

In exchange for lower MA premiums, some plans can reduce the size of their network and increase out-of-pocket costs. However, these plans are still popular.

#2 Closing the Medicare Drug Coverage Gap

The ACA phased out the costly “donut hole” drug coverage gap. Before 2011, Medicare beneficiaries paid 100% for prescription drugs while in the donut hole.  Medicare Part D enrollees only paid 50% of the cost for brand-name drugs while in the donut hole, as of 2011. 

Out-of-pocket costs for generic and brand-name drugs were reduced to 25% in 2020 .

#3 Affordable Care Act Covers Preventive Services

Another way the ACA has impacted Medicare is by covering preventive services without charging you a deductible, copayment or coinsurance. The ACA requires Medicare plans to cover evidence-based preventive services and eliminate cost-sharing. Based on your age and health plan, you may have more affordable access to the following services:

  • Tests for heart disease and diabetes, including blood pressure and cholesterol

  • Cancer screenings

  • Counseling to quit smoking, lose weight, reduce alcohol use and treat depression

  • Vaccinations

  • Flu and pneumonia shots

Preventive Medicare services that do not charge the Part B deductible include:

If you currently have ACA coverage and want to switch to Medicare, Healthcare.gov advises you to cancel your Marketplace insurance after ensuring your new Medicare coverage will start. But if you or your spouse have active health insurance from a current employer, you can defer Medicare enrollment and avoid paying late enrollment fees.

Still have questions? Senior Healthcare Direct can help. Call 1-833-463-3262, TTY 711 to speak with a licensed agent, or get your quote today!

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LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.