It seems so simple: If you have Medicare, ignore the Affordable Care Act.
It. Is. Not. For. You.
And yet, it seems to be the confusion that won't go away.
So, we're going to give it another go — this time, straight from the mouth of Mary Agnes Carey, a Washington, D.C., reporter who has a thorough understanding of both the policy and politics of health reform from covering health care policy and politics on Capitol Hill for more than 15 years.
Carey is now focused on implementation of the Affordable Care Act in her role as a senior correspondent for Kaiser Health News. Previously, she covered the battle over the Patients' Bill of Rights and creation of the Medicare prescription drug program.
A frequent radio and television commentator, she has been featured on the Nightly Business Report, PBS NewsHour and on NPR affiliates nationwide. She had worked for newspapers in Connecticut and Pennsylvania before moving to Washington in the late 1990s when she followed the rise and fall of President Clinton's health care plan, working as Capitol Hill Bureau Chief for Congressional Quarterly, as an editor at CQ HealthBeat and at Dow Jones Newswires.
Carey, who holds a master's in journalism from Columbia University, lives in Washington with her husband and two children.
She answers some frequently asked questions about Medicare and the health law:
1Does the health care law offer any new benefits for Medicare beneficiaries?
Beneficiaries receive more preventative care services — including a yearly wellness visit, mammograms, colorectal screening, and more savings on prescription drug coverage. By 2020, the law will close the Medicare gap in prescription drug coverage, known as the doughnut hole. Seniors will still be responsible for 25 percent of their prescription drug costs.
2Does the law cut spending on Medicare?
Medicare spending will continue to expand as more and more baby boomers reach 65. However, the law does cut the expected growth of Medicare spending by about $716 billion over the next decade.
Medicare officials stress that the spending changes will not reduce Medicare benefits.
Those cuts will be made by lowering reimbursements to nursing homes, hospitals, home health agencies and other providers. It also cuts payments to Medicare Advantage plans to bring those payments closer to what Medicare pays for care for beneficiaries enrolled in the traditional fee-for-service plan.
(Some worry those cuts could lead to access problems, if providers drop out of the program. In the most recent Medicare Trustees report, Paul Spitalnic, then acting chief actuary for the Centers for Medicare and Medicaid Services, wrote that over the long term, some of the health law's changes would cause Medicare payment rates for home health, hospital and other services to drop below those now paid by the Medicaid program, "which have already led to access problems for Medicaid enrollees.")
3Does the health law require higher-income Medicare beneficiaries to pay more for Medicare prescription drug coverage?
Yes. Currently, Medicare beneficiaries who earn more than $85,000 ($170,000 for a couple) pay more for their Medicare Part B premiums, which cover physician and outpatient services. The Affordable Care Act assigns that same sliding-scale — for those with incomes of more than $85,000 ($170,000 for a couple) — to the prescription drug program in Medicare Part D. Those income thresholds are frozen through 2019.
4I've heard a lot about something called the Medicare "doc fix." What is that and does the health law fix it?
The "doc fix" refers to the sustainable growth rate, or SGR, which is the payment formula based on economic growth that Medicare has used to pay physicians since the late 1990s. Over the past decade, the formula would have cut Medicare physician payments but Congress has stopped the cuts. For example, it calls for a 25 percent drop next Jan. 1. Doctors warn that if the pay reductions were to take effect, fewer physicians will treat Medicare patients.
The health law does not change that formula, but there is bipartisan legislation pending on Capitol Hill that would. The House Energy and Commerce Committee passed a measure in July to repeal the SGR but the bill does not specify how to finance a fix. The House Ways and Means Committee and the Senate Finance Committee are working on legislation as well.
5The health law creates something called a health insurance marketplace. What is that and can I apply for coverage on an exchange?
There is no need for you to enroll in the health law's exchanges. It's an online marketplace where individuals and small employers without group coverage will be able to shop for insurance coverage. Enrollment begins Oct. 1 for policies that will go into effect Jan. 1.
Medicare is not part of the health insurance exchanges. Seniors will still get health coverage through Medicare's traditional fee-for-service program or Medicare Advantage plans, private health insurance plans that are approved by Medicare. Those who are enrolled in Medicare Part A, which covers hospital care, or the Advantage plans will meet the health law's mandate for individuals to have insurance.