How Will the Affordable Care Act Affect Medicare?

The Patient Protection and Affordable Care Act, also known as Obamacare, is set to take full effect next year. The legislation is set to cut $716 billion from Medicare and will bring some significant changes to the program. The Affordable Care Act has already expanded Medicare coverage to include preventive care, and it’s slowly closing the coverage gap in Medicare Part D. 

The Affordable Care Act aims to improve the quality of hospital care for seniors by rewarding hospitals that provide quality care with increased funding, and penalizing those who provide poorer care with decreased funding. Although the legislation does cut some Medicare programs, these cuts aren’t intended to affect benefits; instead, they’re meant to increase Medicare’s cost-effectiveness by moving the money to areas of the program where it can be put to better use.

How Are Medicare Benefits Changing?

The Affordable Care Act broadens existing Medicare benefits, making it possible for seniors on Medicare to receive preventive care with no out-of-pocket costs. Seniors can now get check-ups, cancer screenings, vaccines and other forms of preventive care for free. These changes have been in effect since 2011.

Another important change in Medicare benefits under the Affordable Care Act concerns the so-called “donut hole,” or the coverage gap in Medicare Part D. Under Medicare Part D, many seniors must pay for their own prescription drug costs. As of 2012, seniors receiving Medicare became eligible for discounts on brand-name and generic prescription drugs. These discounts will grow each year until 2020, when the coverage gap should close completely, and Medicare recipients will only need to pay co-pays for their prescription drugs.

The Affordable Care Act also aims to reduce federal spending on Medicare Advantage, a form of supplemental Medicare insurance administered by private insurance companies. Medicare Advantage, which was originally intended to reduce federal spending on Medicare, has turned out to cost the government 14 percent more per patient than traditional Medicare. It is hoped that cutting federal spending on Medicare Advantage will lower overall Medicare costs.

What Is the Value-Based Payment Provision?

Under the Affordable Care Act, providers who offer high-quality care to Medicare patients stand to receive a one percent increase in Medicare payments in 2014, and a two percent increase in Medicare payments in 2015. Conversely, those who provide a lower standard of care — as measured by high re-admittance rates and patient dissatisfaction — stand to lose up to two percent of their payments from Medicare by 2015.

In this way, the Affordable Care Act intends to improve the quality of care seniors receive.Quality care is something that professionals in the field will have to focus on. Though it may have gone unmentioned before, health care employees had better take notice or suffer the consequences. Human services will be especially influential in this regard and it is anticipated that more positions in human resources will be created to address the importance of quality care. To learn more about earning a human services degree online, you can research online for a program that fits you. 

Where Are the Medicare Cuts Coming From?

According to the Congressional Budget Office, the anticipated total cost of Medicare over the next 10 years will be about $7.5 trillion. Between 2013 and 2022, the Affordable Care Act plans to cut $716 billion from Medicare. Of that amount, $415 billion comes from federal payments to care providers and private insurance companies. The rest of the cuts come from parts of the program that are not considered to be cost effective, such as the Medicare Disproportionate Share Program, which compensates hospitals for treating lower-income Medicare recipients who do not have supplemental insurance.

How Does the Affordable Care Act Change Medicare Funding?

The Affordable Care Act changes Medicare funding by reallocating the $716 billion in cuts to other parts of the program, where it’s believed the money can be put to better use. The new law will also levy a 0.9 percent tax on members of the top tax bracket in order to raise money for the new law.

The legislation also allows for the creation of an Independent Payment Advisory Board, which will have the authority to recommend reduced provider payments if Medicare spending grows too fast in the future. Payments from Medicare to health care providers will also grow at a slower rate. These two things are intended to keep Medicare costs down in the future. Medicare is expected to cost $900 billion per year by 2022.

The Affordable Care Act has expanded Medicare benefits to include preventive care like checkups, vaccines and cancer screenings. Over the next several years, it will gradually close the coverage gap in Medicare Part D, which provides prescription drug coverage to seniors. It will also cut spending on Medicare Advantage and tie providers’ payments to the quality of the care they give. The Affordable Care Act intends to fund these changes and keep Medicare solvent in the future with $716 billion in cuts to other parts of the program and with a 0.9 percent tax increase on members of the top bracket.

About the Author: Contributing blogger Alisa Martin has more than 15 years of experience in public health policy. She currently works with his local government to improve public health services.