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Ask the Expert: Conflicting Information About Medicare and the ACA
Q. A few days ago, in an article by Oscar Garcia of the Social Security Administration, I read that "People who have Medicare coverage are not affected by the Affordable Care Act." In my own personal experience, I don't think he is completely correct. I am on Medicare and personally, I have been affected by the Affordable Care Act (ACA). I have taken advantage of the wellness visits and prescription drug savings. In fact, as an example, before the ACA, I was told I had to pay $160 in cost-sharing for a colorectal cancer screening. Today, this important screening and many others are covered at no cost to me (with no deductible or co-pay). I have also read in many places that the ACA is playing an important role in improving the financial viability of Medicare. In light of this conflicting information, can you clarify whether seniors on Medicare are or are not affected by the ACA?
A. Mr. Garcia is correct that people covered by Medicare do not need to replace Medicare coverage with plans offered in Marketplace coverage. Please read our recent article about this subject. As you noted, however, people with Medicare are affected by the ACA. According to the Centers for Medicare & Medicaid Services (CMS), below are some examples of how the ACA positively affects seniors on Medicare:
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Preventative Services: The ACA helps tear down a significant barrier for some seniors to staying healthy and helps their care providers prevent, identify and treat problems early.
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More than 25.4 million senior citizens and others covered by Medicare received at least one preventive service at no cost to them during the first eleven months of 2013, because of the Affordable Care Act.
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Before the Affordable Care Act, Medicare recipients had to pay part of the cost for many preventive health services, such as the colorectal cancer screening you described.
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These out-of-pocket costs made it difficult for many seniors to get the important preventive care they needed.
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Annual Wellness Visits: In the first eleven months of 2013, more than 3.5 million seniors and other beneficiaries with Medicare took advantage of the Annual Wellness Visit established by the ACA.
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Financial Viability of Medicare: Provisions of the ACA are proving to be highly beneficial to the future of the Medicare program.
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ACA provisions have had a substantial effect on reducing the growth rate of Medicare spending. Growth in Medicare spending per beneficiary hit historic lows during the 2010-2012 period, and this trend has continued into 2013 (Source: Department of Health and Human Services).
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Medicare spending per beneficiary will grow at approximately the rate of growth of the economy for the next decade, breaking a decades-old pattern of spending growth that outstripped U.S. economic growth. (source: projections by both the Office of the Actuary at CMS and the Congressional Budget Office)
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Accountable Care Organizations (ACOs): Doctors, hospitals and health care providers establish ACOs to work together to provide better health care through closely coordinated services to their Medicare patients, while working to slow the growth of health care cost.
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The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
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According to CMS, when an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.
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There are now more than 360 ACOs working with Medicare to provide higher-quality coordinated care to 5.3 million seniors and other beneficiaries, while reducing the cost of health care (source: HHS)
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Prescription Drug Coverage Savings: The ACA saved seniors $8.9 billion on their prescription drugs since the law's enactment (source: CMS).
You are right in questioning the conflicting information you have read. As you can see, actions resulting from the ACA (also called Obamacare) are certainly having a major effect on seniors on Medicare today, and according to the CMS, will continue to do so in the future.
As you are taking advantage of the benefits of the ACA and planning for your next wellness visit, it is also a good idea to plan for your future and for your loved ones. If you have not done Incapacity Planning, Estate Planning, or Long-Term Care Planning, or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, please contact The Law Firm of Evan H. Farr, P.C. as soon as possible at our Virginia Elder Law Fairfax office at 703-691-1888 or at our Virginia Elder Law Fredericksburg office at 540-479-1435 to schedule your appointment for our no-cost consultation.
Ideas for Dealing with Dementia Symptoms
Dear Big Red,
My grandmother, Rose, is in the early stages of dementia. I am her caregiver in my home. She is starting to experience some disruptive behavior, refuses to go to sleep, and I am beginning to see that a schedule for eating and bathing doesn't work well for her. What are some ideas for dealing with these symptoms?
I.M. Exhausted
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Dear I.M.,
Three institutions are using unconventional, creative approaches for dealing with similar symptoms and they have seen remarkable results in individuals with dementia. These ideas can possibly be implemented with your grandmother in your home.
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Disruptive behavior: At the Life Care Center of Nashoba Valley in Littleton, MA, when someone is upset or disruptive, rather than dispense a sedative, the staff tries to find what triggered the behavior. Could it be a certain place or time of day? For example, one resident had been a librarian. When she became agitated, the staff would hand her a book. She'd relax instantly, flip through the pages, smell and caress it.
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Sleeplessness: Dementia can wreak havoc on an individual's sleep cycle, leading to sleeplessness, night terrors, wandering or agitation. The Hebrew Home of Riverdale heard pleas of caregivers, like yourself, who weren't sleeping at night and couldn't function the next day. To help, the home began offering adult day services -- at night. Those enrolled can socialize, putter in the garden, do yoga, paint, cook, listen to live music or get a mini-massage. They receive prescribed meds, plus physical, aroma- and light therapy.
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Comfort and Schedules: Beatitudes in Phoenix takes a different approach with a focus on comfort. Part of being comfortable means determining individual schedules. If residents want a martini before dinner or a bath at 3 a.m., they get it. They sleep and eat when they want, and do only activities that interest them. A retired nurse, for example, might sit at the nurse's station and "help" by writing notes. "It's something she's done all her life and is meaningful," says Tena Alonzo, director of research.
Persons with dementia and their families face special legal and financial needs. At The Fairfax and Fredericksburg Elder Law Firm of Evan H. Farr, P.C. we are dedicated to easing the financial and emotional burden on those suffering from dementia and their loved ones. When you can no longer care for your grandmother in your home, we can help you prepare for your future financial and long-term care needs. We help protect the family's hard-earned assets while maintaining your loved one's comfort, dignity, and quality of life by ensuring eligibility for critical government benefits. Please call 703-691-1888 in Northern Virginia or 540-479-1435 in the Fredericksburg area to make an appointment for a no-cost consultation.
About Big Red:
Big Red has lived at The Farr Law Firm's Fairfax office for two years, and he belongs to Evan and Jeannie Farr. He resides on the table behind Jeannie's desk and his bowl can often be found on the hall table when you get off the elevator. He loves socializing with the African Dwarf Frogs (Ernie and Jannette) and greeting all of the clients that come to the firm.
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Upcoming Events |
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All Fairfax events are at The Law Firm of Evan H. Farr, P.C., 10640 Main Street, Suite 200, Fairfax, VA 22030, and all Fredericksburg events at at 501 Westwood Office Park, Fredericksburg, VA 22401 from 10 a.m.-12 p.m. RSVP today! We hope to see you there.
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Note: Our next Living Trust Plus: How to Protect Your Assets from the Expenses of Probate and Long Term Care seminars are on January 16, 21, or 30 in Fredericksburg and Saturday, January 11(full), January 18 February 8 or March 8 in Fairfax. View the calendar of upcoming seminars and sign up here.
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Fairfax:
10640 Main Street
Suite 200
Fairfax, VA 22030
703-691-1888
Fredericksburg:
501 Westwood Office Park
Fredericksburg, VA 22401
540-479-1435 | |
