Questions about the Affordable Care Act



The enrollment opportunity for the Affordable Care Act is scheduled to begin November 1, 2016. This enrollment period will continue through February 28, 2017. Because this enrollment will coincide with the Medicare Annual Election Period (October 15 to December 7) we are anticipating a lot of confusion and want to assist in providing information to all of you.

First of all, as a Medicare Beneficiary you DO NOT have to respond to anything related to the Affordable Care Act. If you get something in the mail or get a phone call and are confused please give us a call.

Secondly, there a several scams going around right now directed at seniors and related to the confusion of the Affordable Care Act launch. Do not respond to any email requesting your contact information or call back to an organization based on messages left on your answering machine. Your Medicare is not included in the Affordable Care Act so you do not have to provide any information or communicate with anyone about the new plan.

Finally, there continues to be confusion about the Affordable Care Act, its benefits and how it affects Medicare. Below is a summary of each:

The Affordable Care Act

All individual health plans sold in 2014 will include these 10 Essential Health Benefits:

1. Ambulatory Patient Services (outpatient care)

2. Prescription Drugs

3. Emergency Care

4. Mental Health Services

5. Hospitalization

6. Rehabilitative and Habilitative Services

7. Preventive and Wellness Services

8. Laboratory Services

9. Pediatric Care

10. Maternity and Newborn Care

Currently, less than 2% of the existing health plans on the market provide all 10 of these services.

In addition to the above, the law eliminates lifetime limits on essential medical expense, prohibits carriers from dropping you or raising your rate if you get sick, prohibits carriers from denying coverage due to a pre-existing condition and caps annual out of pocket medical and drug expenses at $7,150 for individuals and $14,300 for families.

If you have friends or family members that need health insurance we will be happy to help.  Give us a call.

What it Means to Medicare Beneficiaries

The biggest impact to Medicare beneficiaries is the closure of the Medicare Part D Coverage Gap (also known as the doughnut hole).  Each year until 2020 the coverage gap will get smaller and smaller until it is completely elimiated on January 1, 2020.  We expect to see drug plan premiums and copays continue to rise each year as a result of the doughnut hole closure.  It is important to review your drug plans annually to ensure you are in the best possible situation given your current medications.  You can review your drug plan at Medicare.Gov or on our new site which can be found here.