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ACA: Basics, ACA: Medicare & Medicaid

12 Days of “Gifts” from the Affordable Care Act – Gift Six: Doing More by Expanding Medicaid and Increasing Benefits for Older Adults

In the spirit of this holiday season, the Wisconsin Alliance for Women’s Health invites you to share in a series of blog posts, each containing a special “gift” from health care reform. Some have already been implemented and some are gifts still to come; but all are very important improvements to our healthcare system.

Gift Six: Doing More: Expanding Medicaid, Closing the “Donut Hole”, Early Retiree Eligibility, and Free Preventative Care for Older Adults

This “gift” comes to us in several different parts, but all have a common theme – they expand services and eligibility for Medicaid or Medicare and allow coverage for older employees who retire early.

Let’s start with closing the “donut hole.” If you are on Medicare you are probably familiar with the “donut hole.” Under the new health care law, effective January 1, 2011, Medicare prescription drug coverage (Part D) became more affordable for older adults. If you reach the coverage gap – or “donut hole” – you will receive the following (click here to read more about this provision):

  • A 50% discount on covered name brand medications when you buy them at the pharmacy or order them through the mail
  • Some coverage for generic medications

The second part of this gift provides early retirees with access to coverage by the Early Retiree Reinsurance Program. The federal government provided $5 billion to employers and unions in order for older employeesas well as their spouses and dependents.  This would help them maintain coverage if they retire between the ages of 55 and 65 – until they become eligible for Medicare. This provision will end on January 1, 2014 when the Affordable Health Care exchanges are set up.

Another part of this gift is great news for older adults: free preventive care for older adults covered under Medicare. These services include yearly wellness visits, screenings – including mammograms and cervical cancer – and tobacco counseling.  This is a big win for women as almost 95% of new of breast cancer cases and 97% of breast cancer related deaths occur in women ages 40 and older and women between the ages of 75 and 79 had the highest incidence rates – making the increased access to preventive care among older adults vital.

Last and certainly not least, is the increased access to Medicaid -another important piece for women who are more prone to be living in poverty compared to males. This provision that takes effect in 2014, will allow individuals who make less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) to be eligible for Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years.

Be sure to check-in tomorrow where we will discuss strengthening community health centers and providing more compensation for rural providers.


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