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Health Care Reform:

Health Insurance & Affordable Care Act

How Health Reform Affects Medicare

Some of your Medicare benefits are getting better because of the Affordable Care Act. For one thing, you should be able to pay less for your medicines. You can still choose your own doctor -- that has not changed.

There still might be some things for you to watch out for, though. For instance, there are some changes for Medicare Advantage plans and for hospital care that could affect your benefits and costs.

You Can Get More Free Care

A lot of preventive care is now free. Preventive care helps you stay well and avoid diseases.

If you have a Medicare Advantage plan, the free health care available to you may vary from plan to plan.

If you have Original Medicare:

You can have a free wellness exam every year. You and your doctor will map out a plan to keep you healthy.

You can get most screenings free. 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 free counseling to help you quit before smoking causes a serious illness.

You'll Save Money on Medicine

The donut hole is shrinking. If you take a lot of prescription drugs, you may know about the donut hole. If you're new to Medicare, the donut hole is a gap in your drug coverage under Medicare Part D.  Here's how it works.

Right now, each Part D plan covers up to $2,970 for medicines a year. 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 47.5% for brand-name prescriptions and 79% for generics. You pay this percentage on your medicines until you have spent $4,750.

In time, the donut hole will go away. Each year from now until 2020, the percentage you pay during this gap in coverage will go down.

In 2020, the hole will be gone. Then, you'll pay 25% for all prescriptions.  It won't matter if you're buying brand name or generic drugs.

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 -- for better or for worse.

The Affordable Care Act says that your insurance company will get a bonus if they improve your Part C plan.   

However, the new law means Medicare will be paying less to some Medicare Advantage plans. In response, some Medicare Advantage plans may cut benefits, like dental care. Or they may increase what you pay in copayments or co-insurance. So, even though the Affordable Care Act didn't cut any benefits, you may lose some.

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