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The Health Care Law & You

The Health Care Law and Medicare

The Affordable Care Act provides several new benefits and protections

En español l The health care law — officially the Affordable Care Act — adds a number of benefits and protections to the coverage you already receive with Medicare.

1. Closes the doughnut hole

If you have prescription drug coverage under Medicare Part D and fall into the coverage gap, or doughnut hole, your out-of-pocket drug costs will be greatly reduced in the future. You'll get discounts on brand-name and generic prescription drugs while you are in the doughnut hole. These discounts will continue to increase until 2020, when the doughnut hole will disappear. Here’s how:

The percentage discounts for brand-name drugs, by year:

2013: 52.5% | 2014: 52.5% | 2015: 55% | 2016: 55% | 2017: 60% | 2018: 65% | 2019: 70%

The percentage discounts for generic drugs, by year:

2013: 21% | 2014: 28% | 2015: 35% | 2016: 42% | 2017: 49% | 2018: 56% | 2019: 63%

However, everyone on Medicare Part D will still have out-of-pocket costs for premiums and copayments, just like now before you reach the doughnut hole.

You will still be responsible for paying your premiums and deductible, as well as 25 percent of your prescription drug costs until you reach catastrophic coverage.

If your costs exceed the catastrophic coverage level, you will be responsible for only 5 percent of your prescription drug costs for the rest of the year.

2. Covers more preventive care

If you have Medicare, you can now work with your doctor on a prevention plan to keep you as healthy as possible. The additional preventive benefits include:

  • A yearly wellness visit

  • Screenings for diabetes and certain cancers. This includes mammograms, colonoscopies and other preventive screenings

The yearly wellness visit is different from a physical. A physical is a more extensive exam. You may choose to have a physical at another visit with your doctor, but Medicare generally will not pay for this service.

If you have a Medicare Advantage plan, you will need to see if your plan pays for a physical exam; otherwise, you will be responsible for payment.

3. Helps improve access to primary care

To ensure that primary care providers are available to give you quality care, the law:

  • Gives primary care providers who treat people with Medicare bonus payments for providing quality care

  • Gives incentives to physicians and nurses who provide primary care in areas with doctor shortages

4. Cracks down on waste, fraud and inefficiency

You are probably concerned about health care fraud. Scams and fraud take money from the Medicare program. The health care law:

  • Provides extra resources to fight fraud and abuse in Medicare

  • Puts in place more tools to catch those who fraudulently bill Medicare

Next page: What changes with Medicare Advantage plans? »

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