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How the ACA Affects Senior Citizens

From requiring prescription drugs to managing common conditions such as high blood pressure and cholesterol, older Americans have a number of health concerns to consider.

With regard to senior citizens,  the Affordable Care Act (ACA) — also known as ObamaCare) — has increased the number of preventive care services available to seniors at no additional out-of-pocket cost.

What Medical Coverage Does ObamaCare Offer to Seniors?

The majority older Americans over the age of 65 are eligible for Medicare. Those enrolled in Medicare Part A (which covers hospitalizations and limited nursing home care, and is free for most beneficiaries) are not eligible for Marketplace coverage. In fact, it is illegal for an insurance company to sell a Marketplace plan to anyone enrolled in Medicare Part A.

For those who do purchase insurance, the ACA provided all Americans with a set bundle of essential health benefits required of all Marketplace-approved plans and any plan sold in the individual or small- group market outside of a Marketplace. Some of these essential health benefits are especially useful to seniors who are ineligible for Medicare. They include:

  • Preventive and wellness services
    This essential health benefit allows seniors to receive preventive care benefits, such as blood pressure and cholesterol screenings, aspirin use for prevention of heart disease for men and women of a certain age, and many others, for a variety of conditions. Adults over the age of 50 are eligible for colorectal cancer screenings, as well.
  • Laboratory services
    When seniors have blood taken to screen for a health condition or are managing a diagnosed chronic condition such as diabetes or high cholesterol, the provision covers the cost of laboratory services.
  • Rehabilitative/Habilitative services and devices
    Older adults who have had a stroke, a fall, or other major health event that would require them to have rehabilitative or habilitative services or devices, such as walkers or other items to aid their recovery, would receive this benefit. Retirees ineligible for Medicare following a major illness may greatly benefit from this ACA provision.

Additional Benefits to Seniors on Medicare

One of the biggest health care challenges for seniors enrolled in Medicare was the “donut hole” coverage gap in the standard Medicare Part D prescription plan. This gap required seniors to pay the full cost of their medications on top of premiums. Currently, the gap occurs when Medicare beneficiaries’ out-of-pocket costs for prescriptions top $2,850 and coverage resumes when a senior pays more than $4,550. The ACA provides older Americans with improved coverage each year until the “donut hole” is completely closed in 2020.

Lower-income seniors on Medicare also benefit from the ACA in a number of ways:

  • There are co-payments for in-home and community-based services covered by Medicare and Medicaid.
  • Widows and widowers have an easier time maintaining low-income eligibility.
  • More robust outreach programs are offered to eligible seniors who are able to enroll in the Medicare Part D Low Income Subsidy, saving them money on prescription drugs.

Seniors on Medicare across a broad range of income levels also stand to benefit from several other ACA provisions:

  • The Community Care Transitions Program (CCTP) aims to improve transitions in care, such as better hospital discharge planning, to avoid readmission to the hospital. The CCTP tests ways to connect seniors with community services and in-home care agencies to help ensure they stay healthy.
  • The ACA requires nursing homes to list their ownership, allowing greater transparency to those requiring round-the-clock care at a dedicated nursing facility. This helps guardians of older adults in need of care better research consumer reports and information on facilities that may be owned by the same group, but that operate under several different names.
  • States are now required to have a process for nursing homes to resolve complaints and to notify residents and their families/guardians well in advance if a facility is closing. This way, these residents and their loved ones can make other arrangements.

When Can Seniors Enroll for 2015 Benefits?

Medicare is available to Americans age 65 and older. Older adults who may not have qualified for Medicare in 2014 may now be eligible in 2015. But what about retirees who are old enough to retire but may not be eligible for Medicare?

These Americans can look to the Marketplace to purchase health insurance if they are no longer covered by employer-based health insurance or do not have retiree health benefits that carry over from an employer and into their retirement period. Individuals with retiree benefits are considered covered under the ACA and do not have to pay the fee associated with not having health coverage.

Open Enrollment for all Americans to obtain health care coverage through the Marketplace in 2015 begins on Nov. 15, 2014, and ends Feb. 15, 2015. Those who have recently retired may be eligible for a special enrollment period outside the 2015 Open Enrollment window.