Jun 8, 2012

Medicare beneficiaries: What can you expect if the Affordable Care Act is overturned?

When it comes to the fate of Medicare and the Affordable Care Act, it's hard to know what to believe. Medicare beneficiaries are a formidable voting bloc, which means that Medicare has long been a political football. And the Affordable Care Act has been a contentious issue, to say the least. The truth seems to get mangled and massaged by political parties for their own benefit. 

So what can Medicare beneficiaries expect if the Supreme Court strikes down the Affordable Care Act this month? We cannot foresee all of the ramifications, but at least one is fairly clear. If you are a Medicare Part D beneficiary, you will need to pony up more for your prescription drugs when you enter the so-called doughnut hole, that period when Medicare does not cover your prescriptions. Right now, the doughnut hole begins when drug expenditures exceed $2930, and ends when expenditures reach $4700.  Under the Affordable Care Act, pharmaceutical companies have offered seniors in the doughnut hole a 50% discount on brand-name prescription drugs, and a 14% discount on generics.  Last year, over three million Americans in the doughnut hole saved a $2 billion. Although the drug companies could voluntarily continue offering these discounts, they will be under no legal obligation to do so.Click here to read Fidelity Investment's analysis of the doughnut hole savings. 

The Affordable Care Act also entitles newly enrolled Medicare beneficiaries to an initial wellness exam, free of charge. Reversal of the law would eliminate this benefit. The law also covers subsequent annual "wellness exams,"  but as the AARP reports, there has been confusion as to what such the annual wellness exam actually covers.

The Center for Medicare and Medicaid Services also predicts disruption in the Medicare system - in terms of paperwork, payments, delivery. That's because their systems have already been modified to coordinate with the Affordable Care Act.  Read more.

We'll know more in a few weeks. Stay tuned. 

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