The key thing that seniors need to keep in mind about the Patient Protection and Affordable Care Act, also known as Obamacare, is that the law specifies that key benefits under Medicare can’t be eliminated or reduced, says Dalton attorney David McGuffey.
McGuffey, who practices elder law, says the law provides that Medicare Part A benefits — which cover hospitals, hospice care and some home health services — and Part B benefits — which cover preventive services, doctor’s fees and extended home health care — can’t be cut.
“I’m really having trouble finding any downsides (for the elderly),” McGuffey said Tuesday during a presentation at the Dalton-Whitfield Senior Center.
McGuffey said the most controversial part of the Affordable Care Act, the requirement that individuals who do not have health insurance must purchase it, does not affect those 65 and older since they are eligible for Medicare coverage.
In addition to preserving key benefits, the law also requires Medicare, the federal program that provides health coverage to those 65 and older, to cover annual physicals, and ends co-payments and deductibles for preventive care such as colonoscopies and mammograms.
McGuffey said the law also aims to reduce the so-called “donut hole” in Medicare Part D. Part D is a federal program that subsidizes health care insurance for Medicare patients. The donut hole is the gap between the routine coverage the plan provides and the catastrophic coverage, the amount that patients have to pay out of pocket. The Affordable Care Act promises to phase that gap out over 10 years.
But McGuffey acknowledged that those who receive their Medicare coverage through a Medicare Advantage plan will likely see some changes. Under Medicare Advantage, Medicare pays a private health insurance company a set amount of money each month to provide health coverage for a beneficiary. Those companies must provide all coverage required by Medicare, but most also offer additional coverage such as vision and dental plans.
McGuffey said Obamacare calls for cuts to payments to Medicare Advantage plans.
“This means they might start cutting some of those optional benefits. But they can’t cut required benefits,” he said.
Roughly one-fourth of Medicare recipients currently choose to receive their coverage through an Advantage plan.
State Rep. Bruce Broadrick, R-Dalton, a professional pharmacist, said the top concern he hears from his elderly patients about Obamacare is whether it will affect their coverage.
“They want to know if they’ll be able to keep their doctor, and they want to know if doctors will continue to accept Medicare. Medicare reimbursements are already so low that some doctors are not accepting new Medicare patients,” said Broadrick, a member of the House Health and Human Services Committee.
In addition to cutting payments to Medicare Advantage plans, the Affordable Care Act also cuts reimbursements to hospitals and created the Independent Payment Advisory Board which has the power to make further cuts in Medicare payments. Unless Congress overrules them, any cuts suggested by the board will take affect.
“There’s always talk about cutting Medicare payments to doctors, but they seem to have a good lobby. Congress always seems to find the money not to make those cuts,” McGuffey said.
But Robert Culp, an assistant professor of economics at Dalton State College, said that without the Medicare cuts that Obamacare’s promised reduction in health care spending may not materialize.
“If they say ‘We can’t do that’ (make cuts), then the savings they were counting on are off the table. The (Congressional Budget Office) has already doubled its cost estimates for this law. Delaying or refusing to make those cuts will just make it more expensive,” Culp said.