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Health Care Reform:

Health Insurance & Affordable Care Act

FAQ: New Exchanges Not for Seniors on Medicare

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Some worry those cuts could lead to access problems, if providers drop out of the program. In the most recent Medicare Trustees report, Paul Spitalnic, then acting chief actuary for the Centers for Medicare and Medicaid Services, wrote that over the long term, some of the health law's changes would cause Medicare payment rates for home health, hospital and other services to drop below those now paid by the Medicaid program, "which have already led to access problems for Medicaid enrollees."

Q: Does the health law require higher-income Medicare beneficiaries to pay more for their Medicare prescription drug coverage?

A: It does. Currently, Medicare beneficiaries who earn more than $85,000 ($170,000 for a couple) pay more for their Medicare Part B premiums, which cover physician and outpatient services. The health law brought that same sliding-scale approach to beneficiaries' prescription drug coverage in Medicare Part D for those with incomes of more than $85,000 ($170,000 for a couple). Those income thresholds will be frozen through 2019.

Q: I've heard a lot about something called the Medicare "doc fix." What is that and does the health law fix it?

A: The "doc fix" refers to the sustainable growth rate, or SGR, which is the payment formula based on economic growth that Medicare has used to pay physicians since the late 1990s. Over the past decade, the formula would have cut Medicare physician payments but Congress has stopped the cuts. For example, it calls for a 25 percent drop next Jan. 1. Doctors warn that if the pay reductions were to take effect, fewer physicians will treat Medicare patients.

The health law does not change that formula, but there is bipartisan legislation pending on Capitol Hill that would. The House Energy and Commerce Committee passed a measure in July to repeal the SGR but the bill does not specify how to finance a fix.  The House Ways and Means Committee and the Senate Finance Committee are working on legislation as well.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

Fri, Sep 20 2013

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