How Obamacare Changes Senior Care

Provisions in the Affordable Care Act affect elder benefits and cost

Senior getting ear screened by doctor
By SHARE

You may have already planned for how you will receive care as you age, but under health care reform you can take into account additional provisions for seniors, including valuable information about elder care and new, free health care benefits. 

Medicare, the federal health insurance program for Americans who are 65 and older, includes added prevention services and lower prescription costs to help maximize the amount of time you can remain healthy and live independently. You also can more easily report suspicious activity to your Medicare plan and expect more options after you leave a hospital.

If you reach a point where you require a range of medical services that a nursing home can provide – needing round-the-clock care for eating, taking medications and help getting in and out of chairs and in bed – your loved ones now have better resources to research and compare homes, as well as to report violations.

[Search U.S. News Top-Rated Hospitals for Geriatrics.]

Here are details about senior care provisions that have rolled out under health care reform in recent years:

Free preventive care for seniors. Under the health law, Medicare provides yearly wellness visits, which allow seniors to consult with their doctor and agree on a personalized plan to stay healthy.

When you call your doctor’s office to schedule your appointment, you should say: “I would like to schedule my free annual wellness benefit,” says Nicole Duritz, vice president for health, education and outreach at AARP. The appointment will include free cholesterol and diabetes screenings, as well as consultations about your diet.

Your doctor will check your blood pressure, ask how you’re feeling and review your medications. If your physical activity has increased from the previous year, she may recommend reducing your medication dosage for high cholesterol. She may say it’s time for you to get a tetanus or flu shot. She may notice from your medical record that you are due for a mammography or colonoscopy, both of which are included under Obamacare at no additional cost.

Still, clarify before every appointment which costs you are responsible for, Duritz says. For example, if your doctor says during your wellness appointment that you need a blood test, would she perform it right then or would you need to make a separate appointment that would then carry an additional cost? Some doctors won’t have time, while others prefer to act right away. You can ask the receptionist these kinds of questions when you are scheduling your appointment.

You will need to keep the cost conversation open with your doctor, Duritz says. Though mammographies and colonoscopies are included as part of free screenings for seniors, you will want to see how your doctor plans to proceed if she discovers something is wrong. For example, if she finds a polyp during a colonoscopy, during which you will be sedated, she will remove it, and the procedure will be listed on your medical bill.

[Read: Will Obamacare Affect Medicare? Myths and Facts.]

Lower prescription drug costs. Medicare Part D, or the portion that covers prescription drugs, is administered by private health insurance companies on behalf of the federal government. Before health care reform many seniors entered the “doughnut hole,” or a gap in which they were responsible for all costs of their prescription drugs until they spent a total of $4,550 for the year. In this gap many seniors would stop taking their medications, take them less frequently or break them in half, Duritz says. This endangered their health.

Beginning in 2013, seniors received a 50 percent discount on brand name prescription drugs and a 20 percent discount on generic drugs. The Center for Medicare & Medicaid Services, the agency responsible for carrying out the details of the health law, estimates that last year’s discounts saved seniors an average of $866 each.

The discounts will grow each year until the doughnut hole is abolished in 2020. Seniors will then pay a $310 deductible and 25 percent of prescription costs.

Protections for Medicare fraud. The health care law adds $350 million over 10 years to catch people who fraudulently bill Medicare, and consumers need to be informed, knowledgeable and engaged in their coverage by reviewing their quarterly summary of benefits, Duritz says. You can review your claims online through MyMedicare.gov or wait to receive them through the mail. “Sometimes innocent mistakes are made that can easily be corrected,” Duritz says. “Other times the charges are intentional and fraudulent.”

Look for charges to doctors in a state other than the one you live in, or for procedures that don’t look correct. Are you a male who was billed for a mammography? Did you see only one doctor but were billed for two? Call your doctor to ask. It could be that he simply consulted with another doctor because of the complexity of your case, Duritz says, or it could be a case of fraud.

Use guidelines from AARP and call the Medicare Office of the Inspector General at (800) 447-8477 if something on your Medicare bill makes you suspicious and if your doctor refuses to answer questions about your bill.

[See U.S. News Best Medicare Plans.]

Improved care for seniors after they leave the hospital. Nearly one in five Medicare patients discharged from a hospital is readmitted within 30 days. The Community Care Transitions Program (CCTP), part of the health law, went into effect in 2011 to run for five years. It helps high-risk Medicare beneficiaries prevent readmissions by connecting them to services in their communities, such as a home health agency, an Area Agency on Aging or an Aging and Disability Resource Center.

“Under the health law one thing is clear: People are going to be coming out of the hospitals a lot faster,” says Dan Reingold, president and CEO of the Hebrew Home for the Aged in Riverdale, N.Y. There is pressure to reduce hospital readmissions, so nursing homes will be prepared to take on more patients for post-acute care, he says, such as recovering after surgery. Nursing homes may even begin to offer a larger variety of services in your own home, Reingold says. Inquire whether home care is offered or whether they have staff who can modify your home by installing a ramp or grab bars.

[See U.S. News-rated nursing homes and search for one near you.]

Improved transparency of nursing home information. If the time comes for your loved ones to select a nursing home for you, then the health law makes more information available to compare homes and monitor care. Nursing Home Compare, a site run by CMS and the basis for Best Nursing Homes, provides information on how much is spent on resident care versus administrative costs, what complaints and violations exist, the hours of care per resident, and staff turnover rates. “You don’t want more money going toward marketing than toward the care of your loved one,” Duritz says.

Listing nursing home ownership is a new requirement under the health law. Todd Whatley, an elder law attorney and adjunct professor at the University of Arkansas School of Law, says that an individual nursing home may have a four or five-star rating but may be owned by a chain that is not reputable. Residing in a nursing home that is a nonprofit or faith-based is also important to some families.

[Read: Questions to Ask on a Home Visit.]

Increased consumer protection for nursing homes residents. It’s now easier for your loved one to file complaints about the quality of care in a nursing home. Your state is required to have a process in place to resolve complaints and to ensure that you’re not retaliated against.

Nursing homes in your state also must meet new requirements if the facility is going to close. Nursing home administrators must tell residents and their loved ones about the closure, giving enough notice that they are able to make plans for relocation. Your state has to ensure all residents have been successfully relocated before the closure.

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senior health
senior citizens
aging
Affordable Care Act
health care reform
Medicare
AARP
fraud
prescription drugs
medical prevention
consumers