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Health Law and Regulation


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ACA Prevention Benefits Increasing Access, Lowering Costs for Medicare Patients

In less than two months, more than 150,000 seniors and others with Medicare have received an annual wellness visit. This is a preventive benefit now covered by Medicare free of charge when obtained by a participating healthcare professional because of the Affordable Care Act (ACA), along with many other recommended preventive services, according to an HHS report. The report also shows that this enhanced preventive benefits coverage will lower costs, including lowering Medigap premiums for employers, states and people with Medicare. Many more people with Medicare are expected to receive annual wellness visits and other recommended preventive services because of the ACA.

The report shows that an average of 2,800 Medicare patients have received an annual wellness visit per day between January 1 and February 23, with help from the ACA. Because Congress has eliminated the part B coinsurance and deductibles for the annual wellness visit and many other preventive services, the report says that the use of these services should increase. This will make a difference for people with Medicare who, like most Americans, tend to use preventive services at roughly half the recommended rate. For example, only 43 percent of women with Medicare received a mammogram in 2008.

The ACA encourages beneficiaries to use more preventive services by waiving the usual coinsurance and deductible requirements for services recommended by the United States Preventative Services Task Force (USPSTF) as well as for an annual wellness visit. If those recommended services are obtained from qualified and participating healthcare providers, there are no out-of-pocket costs. For example, cancer screenings such as mammograms and colonoscopies as well as tobacco cessation counseling may now be obtained free of charge.

In addition to improving the use of preventive services and creating additional savings for beneficiaries, Medicare’s enhanced prevention benefits will lead to lower premiums for employers who now fill this gap in coverage. The same is true with states that fill in Medicare’s benefit gaps and cost sharing for low-income seniors through Medicaid. Lastly, many seniors buy Medigap insurance to cover Medicare’s cost sharing. With Medicare now paying for annual wellness visits and the part B cost sharing for many preventive services, Medigap premiums should be lower.

Medicare’s use of the new tools provided by the ACA and better management of the program have stabilized premiums for Medicare’s coverage of prescription drugs (Part D) and increased the number of prescription drug plans that voluntarily help fill the donut hole. Along with other efforts to improve care for people with Medicare, the ACA will generate billions of dollars in savings for Medicare, extend the life of the Medicare Trust Fund by 12 years, and help cut costs for seniors and keep them healthy.


Source: U.S. Department of Health and Human Services, March 16, 2011

Medicare Part D: A Comprehensive Analysis of CMS Rules

The complexity and confusion surrounding Medicare's drug benefit have never been greater. This resource distills from thousands of pages of government regulations and guidance the major rules, guidelines and deadlines you need to comprehend this confusing program. With nine detailed chapters on sponsors, eligibility and enrollment, formularies, CMS enforcement and much more, this valuable analytical tool provides answers to questions such as: how does CMS guidance affect marketing, how does enrollment of Medicare/Medicaid dual eligibles affect Part D plans, and more.

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IMPORTANT NOTICE: This information is designed to provide accurate and authoritative information on the business of healthcare. It is distributed with the understanding that Healthcare Intelligence Network is not engaged in rendering legal advice. If legal advice is required, the services of a competent professional should be retained.

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