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ACA: Medicare & Medicaid

Strengthening and Protecting Medicare for Older Women through the ACA

With all the dialogue around Medicare these days, we thought we would do what the Raising Wisconsin Women’s Voices blog does best – tell you how the Affordable Care Act (ACA) really affects Medicare.

Medicare is the highly popular insurance program for 39 million seniors and another 8 million people under 65 receiving Social Security due to disability. There are an alphabet of programs, Part A, B, C, and D: originally Parts A and B (hospital and medical insurance), and later added Part C (Medicare Advantage Plans), and Part D (prescription drug coverage). It is a particularly important program for older women, who often need more health care than older men because they live longer and are more likely to suffer from chronic conditions. And they often have lower Social Security and pension plans than older men, so they have been spending more of their incomes on out-of-pocket health care expenses. But the health care law is helping.

You’ve probably heard that the ACA cuts $500-$700 billion from Medicare to pay for the law. Not true.  The independent Politifact has rated this claim many times, as false or mostly false. It’s mostly false because the law both adds money to Medicare to cover some holes, like the donut hole and preventive care without co-pays (see more on this below), and slows the growth of Medicare spending in the future. It does that in many ways: by incentivizing value and care coordination by providers, eliminating waste, fraud and abuse, and lowering the subsidies to private insurance through Medicare Advantage Plans (which are now about 12-18%) to incentivize competition and lower the overall growth in Medicare spending. This helps the Medicare trust fund remain solvent longer. There’s still work to do to slow health care spending, but Medicare reforms in the ACA will do a big part to help shift our system to providing better value for our dollars.

To see what the ACA provides for seniors in Medicare, we’ve created a great one-page fact sheet. Here are some of the highlights – but please share the entire resource widely.

  • Covering preventive services without co-pays (like annual wellness exams, mammograms, vaccinations, blood pressure, cholesterol, and diabetes testing, and more).
  • Making prescription drugs more affordable for those who fall into the non-reimbursed “donut hole,” and closing it entirely over time.
  • Improving access to primary care, thanks to bonus payments that give primary care providers an incentive to see Medicare patients.
  • Rewarding Medicare providers who meet measurable goals for improving the quality of care (through Accountable Care Organizations, of which many Wisconsin providers are taking part).

Remember, not everything you hear during these election times are true. Get the facts and share the true information!

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