The insurance market is not great for older Americans—those aged 50 to 64 who are too young to qualify for Medicare. And even those who do qualify face rising costs. However, the Affordable Care Act is designed to bring some significant relief to seniors. Here are a few ways your health care costs and coverage will change—and may have changed already—under the new law.
An easier way to buy health insurance on the individual market. If you need to buy health care coverage on your own as an older adult, it can look like the Wild West out there. Prices are high and it’s difficult to compare plans and prices. The new health care exchanges proposed in the law are designed to make it easier to buy health care on the individual market—and the hope is that they will drive costs down in the process. This will hopefully help the 8.9 million uninsured adults within the 50-64 age range to find insurance.
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Health care is still expensive for seniors—and likely will continue to be in coming years.
An easier time getting coverage. Under current law, health insurance providers are allowed to not only charge more for, but exclude from coverage entirely, older adults with health issues—or agree to cover the person except for the costs of a pre-existing condition. Under the new law, insurers will neither be allowed to turn away those with health conditions or refuse to cover these conditions if they are pre-existing.
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Expanded access to Medicaid. Medicaid covers low-income seniors and Americans of all ages. Under the new law, the requirements for the program will be relaxed—allowing more seniors with low income to receive medical care to qualify.
No more donut hole. Under pre-existing law, those seniors on Medicare had to spend a large percentage of their prescription drug costs out of pocket due to the “donut hole”—a huge gap in coverage that cost seniors thousands of dollars a year. Under the Affordable Care Act, the hole has already started to close. Starting in 2011. Seniors received a 50% discount for all drug spending that fell in the “donut hole” category. The hole will close gradually, so that seniors will receive a 75% discount by 2020 until they hit the upper spending limit—at which point Medicare coverage kicks in again, and seniors must pay only 5% of costs. The law also reduces that upper limit—from $6,440 to $4,550.
Lowered costs over time. The law also takes steps to lower health care costs in general over the long term, primarily by reducing premiums for Part B physicians and other services and by slowing the rate of payment growth to hospitals and other health care providers.
An increase in free preventive care services for seniors. In addition, the Affordable Care Act now offers a number of free preventive care services for seniors through Medicare, including yearly wellness visits, help quitting smoking, and free screenings for different types of cancer, diabetes, high cholesterol and cardiovascular health, among other chronic diseases. It also offers mammograms, flu shots, pneumonia shots, the hepatitis B shot, and medical nutrition therapy for those with diabetes and kidney disease at no extra cost.
Health care is still expensive for seniors—and likely will continue to be in coming years. But hopefully the Affordable Care Act will help improve the situation, cover more seniors, and ensure those covered can afford their care.