With the recent news that the Supreme Court will hear arguments on The Patient Protection and Affordable Care Act, we thought it would be a good time to review exactly what benefits and changes the bill will provide for our seniors.  Certainly the bill has been a hot button for political activity since it passed Congress in March of 2010 and will continue to be a major issue in the upcoming 2012 election.  There will be a lot of news over the next few months on the changes and laws that this bill will bring to the health care system so it’s best to be informed on as many of these benefits as possible.  It’s a lengthy and at times confusing bill. At Sevens Home Care we know the changes will certainly affect the elderly and their care as they navigate through the system.  Below are bullet points of issues we feel are specifically related to seniors and particularly Medicare.

Medicare Cuts – Medicare will see its two biggest changes in Medicare Advantage and Home Health.  Overall traditional Medicare benefits will not contain cuts.  However, Medicare Advantage, plans that are run by private insurers such as Rocky Mountain Health Plans, Kaiser Permanente and Humana in Colorado, will see a $132 billion reduction over 10 years.  It should be noted that the federal government has traditionally spent more per person on these plans.  The overall reduction will be phased in over 3 years but in most areas of the United States the reduction will happen over 3 years and has already begun in 2011.

Home Health will see a $40 billion reduction between 2010 and 2019.  Home Health benefits are related to the ‘Skilled’ benefits that fall under the Class A license in the State of Colorado.  This reduction will most likely affect Home Health companies as the reimbursement for certain services will be reduced.

Advisory Board– the Patient Protection and Affordable Care act also calls for the establishing of what is termed an Independent Payment Advisory Board.  This board will be made up of 15 members that will submit legislative proposals to reduce Medicare spending if it’s growing too fast.  The board will review the Consumer Price Index measures over a five-year period from 2009-2013 and if per capita spending exceeds the growth rate, proposals will be submitted to congress and the president to begin in 2014.  It’s important to note that this board has a check and balance as the wording specifically prohibits the board from submitting proposals or ideas that would raise taxes, change benefits or ration care.  This is intended to keep the board from being the defining voice on Medicare reductions.

Prescription Drugs (The Donut Hole)- Many Americans are familiar with the Medicare prescription-drug benefit and the ‘Donut Hole’ problem.  Currently if an individual spends $2,700 on drugs in a year their coverage will stop until they spend $6,154 at which point the coverage starts again, hence the term Donut Hole.  In 2010, the bill immediately began addressing the hole by providing a $250 government assisted benefit to help with $3,454 gap.  Going forward the government will gradually increase payment within the gap until 75% of the cost is covered.

Wellness Visits- additionally Medicare will pay for all annual wellness visits.

We have also attached a video below that provides a great overview of these benefits described above.