How Health Reform Affects Medicare
You Can Get More Care at No Additional Cost
With any type of Medicare coverage, you can have a wellness exam every year without having to pay anything at the time of your visit. You and your doctor will map out a plan to keep you healthy.
You can get most screening services without additional cost. Screenings are medical tests to find illnesses early, when they're easier to treat. For instance, a mammogram is a screening for breast cancer. A colonoscopy checks for colon cancer. You can also be checked for diabetes, high blood pressure, and high cholesterol.
You can get help to kick the habit. If you're a smoker, you can get counseling to help you quit.
You'll Save Money on Medicine
The donut hole is a gap in your drug coverage under Medicare Part D. That hole is shrinking. Here's how it works.
Each Part D plan covers up to $3,310 for medicines in 2016. That amount includes what you pay and what your insurance pays. Once you reach that limit, your prescription benefits go down. That's when you're in the gap -- the donut hole.
For the time you're in the donut hole, your copay for medicines rises to 45% for brand-name prescriptions and 58% for generics. You pay this percentage on your medicines until you have spent $4,850 for 2016.
Each year from now until 2020, the percentage you pay while in the donut hole will go down.
Starting in 2020, you'll pay no more than 25% for all prescriptions.
Something to Watch: Medicare Advantage Plans
If you have a Medicare Advantage plan, which is also known as Medicare Part C, from a private company, your coverage may change from year to year.
The Affordable Care Act says that your insurance company will get a bonus if they improve your Part C plan, and many have succeeded in doing so.
However, many Medicare Advantage plans are also reducing the size of their provider and pharmacy networks. Or they may increase what you pay in copays or coinsurance. That’s why it’s important to shop for plans each year during the Annual Election Period. Given ongoing changes to plan details, it’s a good idea to make sure the coverage you have now continues to be the best one for you.