What’s in the Affordable Care Act for Virginia’s Older Adults?

Over the last couple of years, much of the public debate around health care served to raise the anxiety of seniors who worried that health care reform would involve dramatic cuts in services, limit personal choice of doctors, or create barriers to getting the care that seniors need. But nothing like that has happened and, as it turns out, a great many of the provisions of the Affordable Care Act (ACA) greatly benefit Virginia’s senior citizens.

Lower Cost Prescription Drugs
In the past, Virginia’s seniors were responsible for paying all Medicare prescription drug costs between $2,830 and $6,440 in a year. This gap is called the “doughnut hole”.  Because of the ACA, in 2011 seniors received a 50 percent discount on their brand-name drugs while in the “doughnut hole.” From 2012 – 2019, the drug discounts increase annually so that by 2020, the Medicare “doughnut hole” closes and seniors will pay no more than 25 percent for their prescriptions. Already, more than 114,000 of Virginia’s seniors have saved over $73 million in brand-name prescription drug costs – an average savings of more than $600 per senior – all thanks to the ACA.

Better Preventive Care
Under the ACA, new insurance plans and Medicare will offer preventive care, including screenings for conditions like colorectal and breast cancer and access to an annual wellness visit – all without a co-pay or co-insurance and no deductible to meet. These screenings and checkups catch problems early when treatments are most helpful. Nearly 840,000 Virginia seniors with Medicare have received free preventive services thanks to health reform.

Early Retirees Access to Health Insurance
Retired employees over the age of 55 who do not yet qualify for Medicare may be able to get health care coverage through the Early Retiree Reinsurance Program. This program reimburses businesses for 80 percent of the yearly cost between $15,000 and $90,000 per retiree.  Approximately 140 businesses, other employers and unions in Virginia are using this program to provide health insurance. The program will fade out in 2014 when Health Benefits Exchanges developed in each state will provide a marketplace where consumers can purchase affordable, high-quality insurance on their own.

Other Medicare Benefits Will Stay the Same
The health care law strengthens Medicare by protecting and improving your guaranteed benefits for hospital stays and doctor visits. These Medicare benefits that seniors receive will stay exactly the same. Nothing will be reduced or taken away. You can choose your own doctor or continue to see your current doctors.

Protecting Medicare
The ACA cracks down on waste, fraud and inefficiency in Medicare. The law also has a number of provisions designed to reduce Medicare spending long term. Reforms include payment options focused on health outcomes instead of health procedures. This transitions the provider reimbursement system from paying for quantity to paying for quality.

If you are interested in staying informed about the ACA and its continued implementation in Virginia, visit Virginia Consumer Voices for Healthcare (VCV) at www.vaconsumervoices.org and sign up to receive periodic email updates. You can also endorse VCV’s work and become one of the voices in support of access to affordable, high-quality healthcare for all Virginians.