Medicare and the Affordable Care Act (Obamacare)

Care for seniors will improve.  More preventative care services will be covered and the “donut hole” – the gap in prescription care coverage under Medicare Part D – will get better and, by 2020, the “donut hole” will be eliminated.  So, on the surface, there is good news for seniors.

The other level – the administrative level – presents a much cloudier picture.  The ACA will, among other things, be looking at reimbursement rates to healthcare providers, starting quality assessments of healthcare providers, and imposing increased requirements on health insurance companies who participate in Medicare through Medicare Advantage (Medicare Part C) or through Medigap or Medicare supplement policies.

Some commentators are concerned that reduced reimbursements to doctors may cause some doctors to either stop taking more Medicare patients or stop participating in Medicare altogether.  Insurance companies are determining if they will participate in the health insurance exchanges and what their Medicare Advantage or Medigap coverage will look like and how much it will cost.  And there are many more issues impacting the healthcare industry at the administrative (and financial!) level that are designed to cause dramatic shifts in the way that healthcare is paid for, which will necessarily impact how healthcare is delivered.

Whether those shifts will be for the better or for the worse depends largely on who you ask.  Opponents of the ACA offer bleak predictions about, among other things, whether there will be actual cost savings and the role of administrators and government employees in the healthcare system.  Supporters of the ACA state the changes are necessary to create a sustainable Medicare system and to control spiraling healthcare costs.  Who is right?  We will all find out in the months and years to come.