Since its enactment in 2010, the Affordable Care Act has sparked heated debates and confusion. This issue of O’Connor Elder Law Reporter aims to clarify its impact on seniors. Despite ongoing debates, the ACA stands as the law of the land, bringing significant changes that affect seniors.

Individual Mandate

The ACA requires individuals to have healthcare insurance, with penalties for non-compliance, starting at $95 per adult or 1% of family income in 2014, increasing annually. However, seniors over 65 are exempt due to Medicare eligibility.

Medicare Changes

Despite payment cuts, the ACA safeguards essential benefits like Medicare Parts A and B, ensuring seniors receive even more benefits, as noted by the National Council on Aging.

Changes to Prescription Drug Coverage

The ACA reduces prescription drug costs for Medicare recipients by addressing the “Donut Hole” coverage gap. Previously, Medicare recipients faced out-of-pocket expenses until reaching certain thresholds. The ACA provisions aim to close this gap by 2020, ultimately resulting in seniors paying 25% of all prescription drug costs. This is particularly beneficial as seniors often require more prescription medications as they age.

Preventive Care Expanded

The ACA mandates Medicare to cover preventive care services for seniors, aiming to reduce future medical needs. Previously not covered, these services now include flu shots, counseling for tobacco cessation, cancer and diabetes screenings, and other chronic disease screenings. Additionally, seniors are entitled to an annual wellness visit, previously paid out-of-pocket. This change is widely viewed as beneficial by the senior population.

Changes to Medicare Advantage Plans

Seniors choosing Medicare can opt for traditional coverage or Medicare Advantage Plans, which often include additional services like dental or vision but may require co-pays. The ACA prevents these plans from imposing higher cost-sharing fees for certain treatments and limits non-medical expenditures. Despite potential cuts to these plans totaling $145 billion over 10 years, the impact on seniors’ options remains uncertain and subjective in its benefits.

Non-Medicare Changes

Beyond Medicare adjustments impacting seniors, other beneficial changes are outlined in the law.

No Pre-existing Conditions Clauses

The ACA prohibits health insurance carriers from including pre-existing conditions clauses, ensuring health status isn’t a factor in coverage applications. Additionally, insurers can’t vary premiums based on health, gender, age, or other factors. This equalizes costs across groups traditionally facing higher premiums, like the ill, females, and the elderly. Once enrolled, individuals are protected from being dropped due to illness.

Grants as Incentives to Hospitals

The ACA provides grants to hospitals to incentivize better care for seniors at high risk of frequent hospital readmissions.

The Elder Justice Act

Enacted under the ACA, the Elder Justice Act aims to protect seniors from various forms of abuse and exploitation, including physical, mental, and financial abuse.

Nursing Home Care Changes

The ACA mandates several provisions regarding nursing homes. It requires the Center for Medicare and Medicaid Services to host a website where consumers can access detailed information about local nursing homes, including inspection reports and complaint records. This allows consumers to assess a nursing home’s performance, ownership, staffing levels, and more. Additionally, the law facilitates easier filing of complaints about care quality and prohibits retaliation against complainants. In case of closure, nursing homes must give residents sufficient notice and ensure their relocation. Furthermore, the ACA offers states the option to receive federal grants for expanded criminal background checks on nursing home staff, enhancing patient safety.

Community Based Long Term Services and Supports

The ACA aims to boost home and community-based care for Medicaid enrollees through various state options. These include offering attendant care services and supports through a community first choice option, adding an optional HCBS benefit to the state plan, and reallocating spending to increase community-based services. While these provisions offer enhanced federal matching rates to incentivize states, they lack set standards for access to HCBS and face limitations in funding, particularly in states with budget constraints. Consequently, disparities in HCBS access are likely to persist, with HCBS competing for funding alongside mandated institutional services.

How the ACA is Funded by Seniors

Seniors contribute to funding the ACA through various means. Firstly, there are cuts to Medicare Advantage Plans totaling $145 billion over a decade, impacting seniors enrolled in such plans. Additionally, a 3.8% surcharge tax is imposed on unearned income exceeding $200,000 for singles and $250,000 for couples, affecting seniors in these income brackets. Moreover, the medical expense deduction floor is raised from 7.5% to 10% of Adjusted Gross Income, impacting taxes for 2013. Lastly, working seniors may face a 0.9% Medicare payroll tax on high earners exceeding specified income thresholds, effective since 2013.

Conclusion

The Affordable Care Act introduces numerous changes that will impact seniors and their families. Understanding these changes is crucial for informed healthcare decisions. Given the complexity of these adjustments and the vulnerable nature of seniors, access to reliable resources is essential.

Our firm is committed to assisting seniors and their families navigate these challenges and establish effective legal plans. Please reach out if you require assistance.