This past week marked the third anniversary of the Affordable Care Act (ACA). Let’s celebrate by looking at some of the provisions that directly (and positively) affect seniors.
The ACA:
- Prohibits health insurance companies from imposing lifetime or annual benefit caps on health insurance policies and consumers;
- Requires health insurances to cover proven clinical preventive services without co-pays or deductibles;
- Sets national standards for administrative simplification to reduce the paperwork burden on patients, providers and insurers;
- Prohibits health insurers from refusing to cover individuals based on pre-existing medical conditions;
- Allows all low income persons without health insurance to enroll in their state Medicaid program;
- Financially penalizes hospitals with excessively high rates of hospital-acquired infections;
- Creates a new Innovation Center within the Centers for Medicare & Medicaid Services (CMS) to research, develop, test, and expand innovative programs that improve quality and reduce the cost of care;
- Sets up a program that allows CMS to share savings with doctors and hospitals who take responsibility to improve the quality and cost of care to Medicare enrollees;
- Reforms the Medicare Advantage program to stop overpayments to private health insurance plans saving more than $135 billion over ten years;
- Shrinks and eliminates the Medicare drug plan coverage gap — called the “doughnut hole” — within ten years;
- Directs Medicare to cover, without cost sharing, annual wellness visits and prevention services for all enrollees, and waiving co-insurance for most preventive services;
- Requires nursing homes and other nursing facilities to implement compliance and ethics programs, and to provide clear information on facility ownership;
- Establishes a national independent monitoring program to oversee interstate and large intrastate nursing home chains;
- Sets new powers and authority for the Department of Justice, CMS, and State Medicaid agencies to identify, prosecute and prevent fraud and abuse;
- Creates a national initiative to prevent and eliminate elder abuse, neglect, and exploitation.
Huge challenges still remain, especially leading up to those coming on January 1, 2014 when these reforms all take place on the same day:
The launch of health insurance exchanges/marketplaces and new private health insurance coverage options for millions of Americans, estimated to reach 27 million by the Congressional Budget Office, and with subsidies expected to reach 19 million of them;
- Health insurance market reforms banning medical underwriting and pre-existing condition exclusions in all 50 states, replaced with guaranteed issue of insurance policies;
- Eligibility for all Americans with incomes below 138% of the federal poverty line (about $15K household income for a single adult) to enroll in Medicaid in those states that adopt the expansion.
The ACA is the biggest set of health reforms ever launched in U.S. history. We here at the Fairfax and Fredericksburg Elder Law Firms of Evan H. Farr, P.C. believe that with all of the changes being made as a result of the ACA and the upcoming January 2014 reforms, Medicaid Asset Protection Planning remains one of the best ways to provide for you future long-term care needs. Call 703-691-1888 to make an appointment for a consultation. We can meet with you, access your financial situation and determine strategies for your long-term care plan.
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