Ask the Advisor: Healthcare Reform Constitutionality and Medicare

Ask the Advisor: Healthcare Reform Constitutionality and Medicare

How Did the Supreme Court Decision About the Affordable Care Act Affect Medicare?

Q: I've been listening to news stories about the Supreme Court case over the constitutionality of the healthcare reform law. Was Medicare affected in any way?

A: The Supreme Court recently upheld the Affordable Care Act. While most people understood that the Supreme Court considered the constitutionality of the "individual mandate," many seniors may not have thought much about how the court's decision would affect Medicare. The decision maintains both new senior benefits and $500 billion in Medicare spending cuts over the next eight years. Here's a list of major provisions that affect seniors:

Medicare Part D discounts in the "doughnut hole." Once both drug plan enrollees and their plan have spent the initial coverage amount ($2,930 in 2012), they reach the Part D coverage gap or "doughnut hole." Prior to the Affordable Care Act, seniors paid 100% of drug costs in the doughnut hole, unless they were covered by a plan that provided some gap coverage. Under provisions of the Affordable Care Act, once seniors hit the coverage gap, they get a 50% discount on covered brand name drugs and pay 86% of the plan's costs for covered generic drugs until they spend a total of $4,700 for the year (when catastrophic coverage begins). Some plans offer additional coverage for generics during the gap.

Expanded coverage of preventive services. The healthcare law expanded coverage of screenings for colon, prostate, breast cancer and other preventive services, which are now free if you follow Medicare's recommended frequency for getting the tests. Medicare will also pay for an annual wellness visit to the doctor.

Medicare Advantage plan cuts. So far, seniors have not been widely affected by cuts to Medicare Advantage plans, but many of the changes in reimbursements to plans have not yet taken effect. TSCL remains concerned that the reimbursement cuts would cause plans to drop extra benefits like eyeglasses and hearing aids that they now provide. Of greater concern is whether plan payments will be adequate for insurers to maintain their contracts with Medicare to provide services. When Congress cut plan payments too deeply in the past, insurers pulled out of markets all over the United States, leaving millions of seniors scrambling to find another health plan — most often at higher out-of-pocket cost.

Annual cuts to healthcare providers. The Affordable Care Act provided for a number of cost-cutting mechanisms that cut government spending on hospitals and other healthcare providers. Medicare's Chief Actuary and the Congressional Budget Office have raised doubts that the savings targets can be achieved over a prolonged period of time, without providers dropping out of Medicare. Media reports already suggest that a growing number of Medicare beneficiaries are left with significant uncovered costs as hospitals keep patients listed as outpatients rather than inpatients due to new rules that penalize hospitals for frequent readmissions. TSCL is concerned that these sorts of problems may escalate as provisions of the Affordable Care Act are implemented.