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Medicare and Affordable Care Act

By Jennie L. Phipps ·
Monday, November 25, 2013
Posted: 6 am ET

If you're a Medicare recipient and living in retirement, you don't have to worry too much about the troubled Affordable Care Act, the health care law often referred to as "Obamacare."

Here are five key points about the law and Medicare from the Kaiser Family Foundation, a nonprofit health care research organization that has been providing reliable information about health insurance reform:

  • People with Medicare can't sign up for health care plans sold in the Obamacare exchanges or marketplaces. Insurers are prevented from selling marketplace plans to people known to have Medicare.
  • The Affordable Care Act tax penalty that takes effect next year for people who don't have health insurance does not apply to people covered by Medicare.
  • People on Medicare are not eligible for premium tax credits, the Obamacare subsidies that cut the cost of health insurance. These credits can be used only to purchase insurance plans in the exchanges.
  • Medicare is not sold through the marketplaces. Medicare participants should enroll through, by calling 1-800-Medicare, or by talking to an insurer who sells Medicare Advantage or Medigap plans.
  • Medicare open enrollment does not coincide with the Affordable Care Act enrollment period. Medicare open enrollment ends Dec. 7 for current enrollees who want to change their plans. Otherwise, you can enroll in Medicare within three months of your 65th birthday. Factor that schedule into your retirement planning.

Obamacare Medicare enhancements

Health reform has resulted in some improvements to Medicare. The Kaiser Family Foundation points out that the law:

  • Slowly began closing the "donut hole" funding gap for Medicare Part D prescription drug coverage.
  • Added an annual wellness visit at no additional cost to participants.
  • Eliminated deductibles for preventive care.
  • Instituted some experimental programs linked to improving quality while reducing expense.

The Affordable Care Act also takes some other steps designed to control Medicare costs and make the program more sustainable. Those changes include:

  • Reducing payments to Medicare Advantage plans so they don't cost substantially more to operate than traditional Medicare.
  • Instituting bonus payments to insurers that provide quality service to participants.
  • Reducing payments to hospitals and other medical providers -- but not physicians.

'Death panel'? No

The law also authorized a 15-member independent payment advisory board to suggest ways to slow the growth of Medicare spending. This proposal has proven to be very controversial, with critics dubbing the board a "death panel." As a result, no board members have been nominated and the idea is on hold.

Another widespread idea that the Kaiser Foundation refutes is that the Affordable Care Act is taking money from Medicare and reducing Medicare benefits. "There is no mechanism for taking savings from Medicare and reducing benefits as a result," says Juliette Cubanski, associate director of the Kaiser Family Foundation program on Medicare policy. "If anything, the Affordable Care Act improves Medicare benefits."

Does anything in the law limit care for Medicare recipients based on age -- another persistent rumor?

"The short answer is no," Cubanski says. "That is a false claim. There are no restrictions on care for people who are receiving Medicare."

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1 Comment
March 05, 2014 at 10:45 am

All this is great --- but--- I can't find many doctors who will even take on a patient on MEDICARE INS. What good is Medicare if you can't find a doctor who actually cares about your health?