In the news lately, most of the coverage has been dominated by the upcoming presidential election. However, there has also been significant news breaking about the Affordable Care Act (ACA) for 2017. The most recent news was that United Healthcare (UHC) has opted to leave the ACA exchanges beginning in 2017. The reason for their departure is an estimated $1 billion in losses for 2015 – 2016. Having such a major insurer leave the ACA marketplace has sent shock waves through the industry and rightfully caused quite a bit of fright for many Americans. UHC is not the first and won’t be the last insurer to opt out of ACA exchange coverage. So for our seniors, what do all of these changes and upheavals mean for their Medicare coverage? After all, UHC underwrites the Medicare Advantage Plan and AARP’s Medicare Supplement. Thankfully, the answer is NOT MUCH if anything. Let’s take a look at impacts real or imagined due to the current status of the ACA.
- Medicare isn’t part of the Health Insurance Marketplace that was implemented with the creation of the ACA. Medicare participants will never be asked to replace Medicare with ACA coverage, and there are no additional actions for seniors to take during the period of open enrollment.
- A benefit for Medicare participants because of the ACA is that Medicare is actually covering preventive services that were not fully covered in the past. Now, mammograms and colonoscopies are covered without a deductible charge.
- The ACA “should” not have any additional impact on which doctor or provider Medicare participants are receiving. The quotations are highlighted with the word should because providers have the ability to make business decisions and may at some point decide to deny “Medicare assignment.” These decisions are with the providers, hospitals, and doctors and are not directly tied to any ACA mandate.
- It is true that Medicare premiums are rising and are directly tied to the state of the U.S. economy. For 2016, there was no cost of living increase in Social Security disbursements meaning some recipients felt those increases more than others.
One development within Medicare that bears watching is the current model as part of Medicare Advantage plans in seven states.This plan, called Medicare Advantage Value Based Insurance Design (MA-VBID) will begin in January 2017, and is designed to restructure enrollee cost sharing to model a more clinical-based approach.MA-VBID promotes interventions targeted at Medicare enrollees suffering from chronic illnesses such Diabetes, Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure, Stroke victims, Hypertension, and others.The clinical interventions require enrollees to participate in structured care plans designed to reduce the overall costs of caring for chronic illnesses and in return receive reduced or eliminated co-pays.
This being an election year, the decision of the American people will have the greatest impact on the future of healthcare in our country. We published an objective review of both presidential candidates’ positions on the Affordable Care Act in June, and an update earlier this month. We encourage you to read those posts to help you formulate a decision on whose policies best serve your future as a healthcare professional. For now and the foreseeable future, it is safe to say that Medicare will be unchanged for those who are currently in the system. What Medicare will look like for future seniors is yet to be determined but should become clearer once a new president is elected and the fate of the Affordable Care Act is solidified once and for all.