Aug 6th, 2013 | By | Category: Social Security & Medicare

Medicare Coverage Remains Essentially the Same

Much of Medicare coverage that we seniors have will not change with the implementation of the Affordable Health Care Act (ACA) in 2014. The health care law protects our basic Medicare benefits. Our coverage for doctor and hospital visits does not change.

The one thing it does add is that it ensures we have better access to primary care physicians (PCP). When PCPs treat people on Medicare, they will get bonuses for providing quality care. They will also get bonuses if they provide care in areas where there are doctor shortages.

Bonuses are also offered to Medicare Advantage plans (Plan C) for providing quality care. Recipients who are part of a high-quality Medicare Advantage plan, for example, could get extra benefits or rebates. The ‘quality’ ratings will be available on line for each Plan C. All Plan C’s have to spend 85% of the premium you pay on your care, not on administrative cost. And they cannot charge more than Original Medicare for services.

New Medicare Benefits

The biggest change for medicare beneficiaries is in prevention. The ACA offers more preventive care at no additional cost, and the doughnut hole gradually goes away. The preventive care/screenings/tests include the following:

  • A yearly “wellness” visit to update your personalized prevention plan
  • Bone mass measurements (to see if you are at risk for broken bones)
  • Colon cancer screenings (to check for early signs of cancer of the colon)
  • Diabetes and heart disease screenings
  • Flu shots, pneumonia shots and the hepatitis B shot
  • Glaucoma tests (to check for eye diseases)
  • Pap smear and pelvic exams (to check for early signs of cervical cancer)
  • Mammograms (to check for early signs of breast cancer)
  • See the full list at

As SCJ has said previously, the new ACA also takes a big swing at waste and fraud. A big part of reducing health care costs must occur in stopping the waste that we see in health care delivery.

If you are a senior who has Medicare, you do not need to buy additional coverage through the Health Insurance Marketplace that starts in 2014. The Marketplace is NOT for people who have Medicare. The Medicare Open Enrollment Period (October 15-December 7, 2013) will not change. During this period you will be able to make any changes in your Medicare coverage that make sense to you.

You may also be able to get additional information by calling 1-800-MEDICARE and asking for the SHIP number in your state. SHIP is the State Health Insurance Counseling Assistance Program.

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