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Health Care Reform:

Health Insurance & Affordable Care Act

Health Care Reform and Medicare: FAQ

Answers to your questions about how health care reform affects Medicare.

Q: What will health care reform do to assist seniors with low-to-moderate income who have Medicare and private health insurance yet still have high out-of-pocket medical expenses?

A: The biggest impact health reform will have on costs is the closing of the drug benefit donut hole discussed above. Seniors (and everyone else) are also now eligible for free preventive care and wellness visits.

In addition, there are a number of Medicare Savings Programs (MSPs) available to beneficiaries of limited income. These programs, which were in place prior to health reform, assist Medicare recipients in various ways to pay for co-pays, premiums, deductibles, and co-insurance.

To find out more about the MSP programs in your area, check Medicare.gov. And for a clear and simple-to-understand chart outlining each program, its benefits, as well as income and asset limits, visit the Medicare Savings Programs page on the California Health Advocates web site.

You can also find information on Federal, state, and private assistance programs in your area at www.benefitscheckup.org, a service of the nonprofit National Council on Aging.

Q: Can doctors refuse to accept more Medicare patients?

Yes. Doctors do have the right to stop treating additional Medicare patients.

But doctors cannot abandon current patients and cannot take one new patient and not the next, Stein says.

Due to long-standing efforts (long before health reform) to amend the Medicare physician reimbursement formula, many doctors recently stopped taking new Medicare patients out of concern that their rate of reimbursement would be reduced by 21% as of Jan. 1, 2011.

That cut in pay has once again been postponed and should relieve, at least temporarily, some of the pressure doctors feel, which may make them more willing to see Medicare patients.

Q: Where can I obtain the actual Medicare regulations that state what is covered and what is not? I don't mean the small booklet sent to us every year.

A. State Health Insurance Counseling and Assistance Programs (SHIPs) connect you with counselors in your state who can answer your specific Medicare-related questions and help you to better understand your benefits. These are invaluable resources for seniors and their families who are looking for detailed information.

To find the SHIP near you, visit the Medicare Helpful Contacts page on Medicare.gov.

Another great resource is the nonprofit Center for Medicare Advocacy’s web site. In addition to information on a wide range of Medicare-related topics, you’ll find all the Medicare rates for 2011.

If you have traditional Medicare, you can also visit the Your Medicare Coverage page on Medicare.gov, where you can enter your Medicare ID number to call up specific information about your benefits.

Also on Medicare.gov is detailed information about how Medicare covers hospital services, including premiums, deductibles, and copayments.You can find that in the Medicare & You handbook.

You can also call 800-MEDICARE (800-633-4227).

If you’ve signed onto a Medicare Advantage plan, the specifics of your coverage can be obtained from the insurance company through which you receive your benefits. Call the customer service number on the back of your insurance card to obtain a copy of your benefits handbook if you don’t already have one or to speak with a representative who can answer your questions.

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