Medicare is insurance provided by the federal government to cover individuals over 65 years, younger ones with disabilities, or those living with end-stage renal disease.
While it has been around for a long time, the Affordable Care Act (ACA), signed into law in March 2010, brought a lot of changes and improvements. The ACA is a comprehensive healthcare reform that was designed to contain Medicare costs, increase revenue, streamline and better its delivery systems, and increase the program’s services.
Below are some of the improvements the Affordable Care Act has made to make Medicare more accessible and effective.
Cost Savings Via Medicare Advantage
Medicare Advantage, often called Part C or MA Plans, is provided by Medicare-approved private companies. That makes them significantly more expensive than regular Medicare Plans. However, the ACA made changes to restructure the payments, making them more affordable. Previously, MA plans were approximately 13% higher than traditional medicare plans.
The changes also banned MA plans from charging higher cost-sharing for skilled nursing facility care, kidney dialysis, and chemotherapy.
A Focus On Prescription Drugs
One of the main challenges for people enrolled in Medicare Part D for prescription drug coverage is the “donut hole.” That is a coverage gap in the Part D benefit where the prescription drug costs are higher than the initial plan coverage limit but have yet to hit the catastrophic coverage level.
The ACA immediately began implementing coverage adjustments to ascertain that enrolees only pay 25% of their “donut hole” expenses by 2020 instead of the 100% they paid in 2010 and before. After a few months of the bill being signed, Medicare began sending $250 rebate checks to enrolees stuck in the “donut hole.”
In 2011, seniors also started receiving cost breaks for their drugs while in the “donut hole,” and Part D enrollees only paid for 50% of their brand-name drugs. The ACA had projected to reduce the cost to 25% by 2020. However, the “donut hole” closed in 2019 for brand-name drugs, meaning enrollees only paid 25% of out-of-pocket expenses for prescriptions after meeting the deductible. The Bipartisan Budget Act passed in 2018 helped drop that from 30%.
Now, enrollees don’t pay over 25% for generic and brand-name prescriptions before or during the “donut hole.”
Free Preventive Services
Preventive services are key to helping with early diagnosis and higher chances of curing a disease. The ACA made it easier for individuals to access these services for free via free annual wellness checks, “Welcome to Medicare” visits, personalized prevention plans, or screenings like mammograms. The result is that there is an increased number of people seeking these services.
More Healthcare Access In Underserved Areas
The 2003 Medicare Modernization Act had a provision for Medicare physicians working in health professional shortage areas to receive 10% bonuses. The Affordable Care Act expanded that program to cater to general surgeons as well from 2011 to 2015. Since then, the bonus has been applied to physicians offering mental health and primary care services.
New Medicare Funding
In addition to making changes that benefited enrolees, the ACA also made changes to ensure that Medicare has increased revenue. Therefore, it changed the tax codes, and from 2013, the medicare payroll tax increased from 1.45% to 2.35% for married couples who file jointly with incomes over $250,000 or individuals earning over $200,000.
Cost Containment
There have been numerous cost-containment provisions from the Affordable Care Act that have continually been implemented over the years. Many involve incentives for healthcare providers to demonstrate reduced Medicare spending. In 2014, nearly 20% of original Medicare payments happened via a value-oriented system. It was based on value and quality rather than paying providers on a per-procedure basis.
The US Department of Human and Health Services wanted to increase it to 50% by 2018. They also focused on implementing and improving value-based payment systems in Part D and Medicare Advantage. Since 2012, Medicare started cutting payments to healthcare facilities with high preventable readmission numbers. That applied for hospital discharge after 1st October 2012.
Starting in 2015, hospitals with high preventable hospital-acquired conditions also faced payment reductions following a provision by the ACA. These steps help encourage patient safety plus quality control throughout hospitals plus better use of the tax dollars funding Medicare.
The ACA also bans new contracts between physician-owned hospitals and Medicare and prohibits those that already work with Medicare from expanding. That has helped limit conflict of interests, plus practices that see traditional hospitals carrying heavier burdens.
New Delivery Systems And Policies
The ACA has made numerous efforts to improve Medicare delivery systems to help enhance service-delivery quality and reduce costs. One of the provisions was the Medicare and Medicaid Coordinating Office (MMCO). It was developed to better the care for Medicare beneficiaries with Medicaid. It was also aimed at promoting more cost-effective and efficient ways to provide care.
One of the first things the office did was launch an alignment initiative to spot and address areas where Medicare and Medicaid law differences create issues for beneficiaries.
It also prompted states to develop integrated care initiatives for more effective management and coordination of care for dual eligibles. To ensure that they fully utilize the value-based payment systems, ACA formed the Center for Medicare and Medicaid Innovation.
This is an innovation center authorized to test delivery systems and payment methods for improved quality and lower costs. The end goal is to identify systems that have better outcomes and reduce costs, better results without raising costs, or lower costs without compromising outcomes. The innovation center has also closely collaborated with the MMCO to test models for dual eligibles.
Consumer Protections
In addition to the provisions guaranteeing patient safety in hospitals, the ACA has implemented other measures to protect enrollees in terms of the services they receive from the insurance. One of them was implementing policies to establish a Medical Loss Ratio. That ensures that enrolee’s premiums go towards health care.
They also took the initiative to make it easier for enrollees to navigate their insurance confidently. The ACA requires that enrollees have access to coverage summaries and term glossaries to make them easier to understand.
There should also be coverage examples and out-of-pocket cost estimates for the common conditions affecting Medicare enrollees. That makes it easier for them to compare the Medicare class they want.
Conclusion
The Affordable Care Act has enhanced the lives of numerous Americans who depend on Medicare plus their families. It promotes Medicare beneficiaries’ health and wellness by emphasizing quality, prevention, and care coordination.
The provisions help reduce healthcare cost growth, make healthcare easily accessible, and ensure that future generations enjoy higher service quality by reforming delivery systems.
Medicare is insurance provided by the federal government to cover individuals over 65 years, younger ones with disabilities, or those living with end-stage renal disease.
While it has been around for a long time, the Affordable Care Act (ACA), signed into law in March 2010, brought a lot of changes and improvements. The ACA is a comprehensive healthcare reform that was designed to contain Medicare costs, increase revenue, streamline and better its delivery systems, and increase the program’s services.
Below are some of the improvements the Affordable Care Act has made to make Medicare more accessible and effective.
Cost Savings Via Medicare Advantage
Medicare Advantage, often called Part C or MA Plans, is provided by Medicare-approved private companies. That makes them significantly more expensive than regular Medicare Plans. However, the ACA made changes to restructure the payments, making them more affordable. Previously, MA plans were approximately 13% higher than traditional medicare plans.
The changes also banned MA plans from charging higher cost-sharing for skilled nursing facility care, kidney dialysis, and chemotherapy.
A Focus On Prescription Drugs
One of the main challenges for people enrolled in Medicare Part D for prescription drug coverage is the “donut hole.” That is a coverage gap in the Part D benefit where the prescription drug costs are higher than the initial plan coverage limit but have yet to hit the catastrophic coverage level.
The ACA immediately began implementing coverage adjustments to ascertain that enrolees only pay 25% of their “donut hole” expenses by 2020 instead of the 100% they paid in 2010 and before. After a few months of the bill being signed, Medicare began sending $250 rebate checks to enrolees stuck in the “donut hole.”
In 2011, seniors also started receiving cost breaks for their drugs while in the “donut hole,” and Part D enrollees only paid for 50% of their brand-name drugs. The ACA had projected to reduce the cost to 25% by 2020. However, the “donut hole” closed in 2019 for brand-name drugs, meaning enrollees only paid 25% of out-of-pocket expenses for prescriptions after meeting the deductible. The Bipartisan Budget Act passed in 2018 helped drop that from 30%.
Now, enrollees don’t pay over 25% for generic and brand-name prescriptions before or during the “donut hole.”
Free Preventive Services
Preventive services are key to helping with early diagnosis and higher chances of curing a disease. The ACA made it easier for individuals to access these services for free via free annual wellness checks, “Welcome to Medicare” visits, personalized prevention plans, or screenings like mammograms. The result is that there is an increased number of people seeking these services.
More Healthcare Access In Underserved Areas
The 2003 Medicare Modernization Act had a provision for Medicare physicians working in health professional shortage areas to receive 10% bonuses. The Affordable Care Act expanded that program to cater to general surgeons as well from 2011 to 2015. Since then, the bonus has been applied to physicians offering mental health and primary care services.
New Medicare Funding
In addition to making changes that benefited enrolees, the ACA also made changes to ensure that Medicare has increased revenue. Therefore, it changed the tax codes, and from 2013, the medicare payroll tax increased from 1.45% to 2.35% for married couples who file jointly with incomes over $250,000 or individuals earning over $200,000.
Cost Containment
There have been numerous cost-containment provisions from the Affordable Care Act that have continually been implemented over the years. Many involve incentives for healthcare providers to demonstrate reduced Medicare spending. In 2014, nearly 20% of original Medicare payments happened via a value-oriented system. It was based on value and quality rather than paying providers on a per-procedure basis.
The US Department of Human and Health Services wanted to increase it to 50% by 2018. They also focused on implementing and improving value-based payment systems in Part D and Medicare Advantage. Since 2012, Medicare started cutting payments to healthcare facilities with high preventable readmission numbers. That applied for hospital discharge after 1st October 2012.
Starting in 2015, hospitals with high preventable hospital-acquired conditions also faced payment reductions following a provision by the ACA. These steps help encourage patient safety plus quality control throughout hospitals plus better use of the tax dollars funding Medicare.
The ACA also bans new contracts between physician-owned hospitals and Medicare and prohibits those that already work with Medicare from expanding. That has helped limit conflict of interests, plus practices that see traditional hospitals carrying heavier burdens.
New Delivery Systems And Policies
The ACA has made numerous efforts to improve Medicare delivery systems to help enhance service-delivery quality and reduce costs. One of the provisions was the Medicare and Medicaid Coordinating Office (MMCO). It was developed to better the care for Medicare beneficiaries with Medicaid. It was also aimed at promoting more cost-effective and efficient ways to provide care.
One of the first things the office did was launch an alignment initiative to spot and address areas where Medicare and Medicaid law differences create issues for beneficiaries.
It also prompted states to develop integrated care initiatives for more effective management and coordination of care for dual eligibles. To ensure that they fully utilize the value-based payment systems, ACA formed the Center for Medicare and Medicaid Innovation.
This is an innovation center authorized to test delivery systems and payment methods for improved quality and lower costs. The end goal is to identify systems that have better outcomes and reduce costs, better results without raising costs, or lower costs without compromising outcomes. The innovation center has also closely collaborated with the MMCO to test models for dual eligibles.
Consumer Protections
In addition to the provisions guaranteeing patient safety in hospitals, the ACA has implemented other measures to protect enrollees in terms of the services they receive from the insurance. One of them was implementing policies to establish a Medical Loss Ratio. That ensures that enrolee’s premiums go towards health care.
They also took the initiative to make it easier for enrollees to navigate their insurance confidently. The ACA requires that enrollees have access to coverage summaries and term glossaries to make them easier to understand.
There should also be coverage examples and out-of-pocket cost estimates for the common conditions affecting Medicare enrollees. That makes it easier for them to compare the Medicare class they want.
Conclusion
The Affordable Care Act has enhanced the lives of numerous Americans who depend on Medicare plus their families. It promotes Medicare beneficiaries’ health and wellness by emphasizing quality, prevention, and care coordination.
The provisions help reduce healthcare cost growth, make healthcare easily accessible, and ensure that future generations enjoy higher service quality by reforming delivery systems.
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