Health Reform: What's Already Changing?

The Patient Protection and Affordable Care Act (usually abbreviated as the ACA) has been discussed, debated, and finally upheld by the U.S. Supreme Court. Yet many people are unaware of the breadth of the improvements to our health care system that will result from the implementation of this legislation. In fact, many of the features of the ACA already have started and saved us a lot of money or improved the quality of our health care.

One change that has helped millions of Seniors on Medicare relates to the coverage gap in Part D prescription drug plans. Until the ACA, Medicare beneficiaries often fell into a “donut hole” period when they suddenly had to pay 100% of the cost of expensive brand-name drugs instead of receiving a 75% discount. However, since 2011 the coinsurance for these drugs has dropped to 47.5% in the coverage gap. And this reduction is scheduled to continue until people will pay only 25% as they do during the initial discount period. So far 5.1 million people on Medicare have saved over $3.1 billion on their prescriptions.

The ACA has eliminated the lifetime cap on how much insurance companies will pay to cover a patient’s bills. No longer do people have to fear running out of coverage when they need expensive treatment. In 2014 the annual limit to medical insurance coverage also will be eliminated. So a really bad year with high medical costs won’t be an added burden.

All of us pay for Medicare fraud when health care providers make bogus claims and receive payment from Medicare for services and equipment that was never provided. Because of an extra investment in Medicare fraud investigation, prosecutions increased 79% in 2011 compared to 2008. In one year $4.1 billion was recovered from criminal convictions.

There is much more happening and improving our health care system thanks to the ACA. I’ll write about this again and provide some details about how California specifically has benefited from health reform.

Bob Petty, PhD

Medicare/Social Security Adviser

Partners For Transitions, LLC