Medicare and Healthcare Reform

I was talking to a client this weekend and she is clearly not a fan of “Obamacare”, as she called it.  As we talked, she raised several of her concerns about the future of Medicare and health care in general.  I thought it was interesting that each of her concerns is addressed under the Affordable Health Care Act that was passed earlier this year.

Relief in the Donut Hole:

“Karen” (name changed) takes several brand drugs and will go into the donut hole in September.  She said she was fortunate last year that her doctor gave her samples of Plavix so she didn’t have to pay full price while she was in the donut hole.  This year she says she’s going in the donut hole even earlier.

I told Karen that she will receive a check for $250 when she goes into the donut hole this year – thanks to the Affordable Healthcare Act. I told her she will get more relief next year when she will pay half-price for her brand name prescriptions while in the donut hole.  I also told her that the Affordable Health Care Act includes the phasing out of the donut hole over the next several years.

Karen was pleased to learn that she will get some help with her high drug costs and she had not heard of these benefits that are part of the Affordable Health Care Act.

Holding the Line on Expensive Imaging Tests:

Karen’s last job was with a group of orthopedic specialists and she said she thought they ordered too many MRIs and other expensive tests.  She also said this group of doctors owned the imaging center to which patients were referred.

I told Karen that the Affordable Health Care Act cuts payments to doctors for many of these expensive tests and sets new rules for doctors who have a financial interest in imaging centers and equipment.  These new rules are designed to cut down on the rising number of MRI’s, CT and PET scans, many of which seem to benefit the doctors’ bottom line more than their patients.  Karen thought this was a good idea.

Focus on Primary Care doctors:

Karen said her experience with specialists showed her that they make lots of money, but she is concerned about primary care doctors because she has heard there are not enough of them to treat new patients and the elderly.

I informed Karen that the Affordable Healthcare Act will raise the Medicare payments for primary care physicians by 10%.

Going Broke from Medical Bills:

Karen said she has an ongoing fear that a chronic illness or cancer might wipe out the money she and her husband  have saved up for their retirement.  Karen has a Medicare Advantage plan and I reminded her that she has a cap on her annual out-of-pocket expenses.  So if she spends $3,400 on co-pays for medical services during the year, she will hit her cap and will have no more co-pays for the rest of the year.

I told Karen that the Affordable Health Care Act requires that all Medicare Advantage plans have such a cap starting in 2011.  Karen is already in a plan with a cap because I don’t suggest people enroll in a plan without one.  Next year every Medicare Advantage plan will have a cap on enrollees’ expenses.

Karen was relieved to hear this news. She had forgotten about this detail in her plan and she said she would sleep better knowing that she has some protection from medical bills.

As we ended our conversation I did not ask Karen if her view of “Obamacare” had changed.  I don’t want to get into political discussions with clients, but I clearly need to educate them about the very positive benefits that are coming to their Medicare coverage as a result of the Affordable Healthcare Act.

What Next?

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