Benefits For Seniors In The Affordable Care Act

March 22, 2011 8:50 am ET

March 23rd marks the one-year anniversary of the Affordable Care Act being signed into law, bringing with it many new benefits for seniors. The law improves the quality and scope of health care for seniors by closing Medicare's prescription drug benefits gap; empowers seniors to stay in their homes and still receive long-term care services; guarantees comprehensive preventive care coverage; and eliminates insurance company loopholes that have been used to deny coverage. By slashing government waste, fraud, and abuse within the Medicare and Medicaid systems, the new law not only saves taxpayer dollars but also provides seniors with better coverage. The Affordable Care Act empowers seniors to have more freedom and gives them back control over their health care decisions.

The Affordable Care Act Improves The Quality Of Medicare

Closing The Medicare Prescription Drug "Donut Hole"

The "Donut Hole" Is The Gap In Drug Coverage When Annual Costs Are Between $2,830 And $6,440. reported: "What's the donut hole? In addition to a $310 deductible, Medicare beneficiaries pay 25% of their drug costs until the total reaches $2,830 for the year. Then, they fall into a coverage gap. At that point, enrollees must pay all costs out of pocket until their annual expenses exceed $6,440. After that, seniors pay 5% of drug costs for the rest of the year." [, 6/7/10, emphasis added]

3 Million Seniors Enrolled In Medicare Received $250 Rebate Check To Address Costs Of The "Donut Hole" From 2010. From The Hill: "Three million seniors in the so-called 'doughnut hole' have already received discounted prescription drugs through a highly touted provision of the healthcare reform law, President Obama's health department announced Friday morning. According to the Friday morning announcement, three million Medicare beneficiaries in 2010 received a one-time, tax-free $250 rebate check for costs in the doughnut hole." [The Hill, 1/21/11]

The Law Eventually Phases Out The Coverage Gap, And In 2011, Seniors Who Reach It Receive A 50 Percent Discount On Brand Name Prescription Drugs. From the Huffington Post: "The rebate checks come as the first step in a larger effort to close the gap in Medicare prescription drug coverage. Starting in January, beneficiaries will begin receiving a 50-percent discount on brand name drugs, and eventually the gap in coverage will be closed completely." [Huffington Post, 8/31/10]

  • Manufacturers That Produce The Majority Of Brand Names Drugs Used By Medicare Patients Participate In The Discount Program. According to, "If a drug company has signed an agreement to participate in the Discount Program, all of the covered Part D brand-name drugs they make are covered during the coverage gap for that calendar year. ... In 2011, manufacturers that produce over 99% of the brand-name drugs used by people with Medicare are participating in this program." [, November 2010]
  • Seniors In The Donut Hole Get Additional Discounts On Generic Drugs. According to Seniors "will also get a 7% discount on generic drugs while in the Donut Hole" and "can expect additional savings on [their] covered brand-name and generic drugs while in the coverage gap over the next 10 years until the gap is closed in 2020." [, 12/27/10]

Protecting Health Care Benefits For Early Retirees

The Affordable Care Act Helps Early Retirees With Health Benefits. According to The Hill: The Affordable care Act "set aside $5 billion [for the Early Retiree Reinsurance Program] to help employers and unions cover the healthcare costs of retirees who are older than 55 but don't yet qualify for Medicare. The program is aimed at stemming the tide of businesses dropping their retiree health coverage. The percentage of large firms offering such a benefit dropped from 66 percent in 1988 to 29 percent in 2009, according to HHS, largely because of rising costs ... The program is supposed to last until Jan. 1, 2014, when many people will start receiving subsidies to buy insurance on the new state health insurance exchanges."  [The Hill, 8/31/10]

  • The Early Retiree Reinsurance Program Benefits Small And Large Businesses, State And Local Governments, And Others. The program "provide[s] financial assistance for employers, including large and small businesses, State and local governments, educational institutions, non-profit organizations, and labor unions." [, 8/31/10]
  • Americans Who Retire Before Being Eligible For Medicare Face "Exorbitant" Health Care Rates And Costs. From the U.S. Department of Health and Human Services: "Many Americans who retire before they are eligible for Medicare without employer-sponsored health coverage see their life savings disappear because of medical bills and exorbitant rates in the individual health insurance market. Health insurance premiums for older Americans are over four times more expensive than those for young adults, and the deductible these enrollees pay is, on average, almost four times that in a typical employer-sponsored insurance plan." [, 3/2/11]

5,000-Plus Employers Participate In The Early Retiree Reinsurance Program Benefiting Over 4.5 Million Americans. From the U.S. Department of Health and Human Services: "[T]he Early Retiree Reinsurance Program (ERRP) created by the Affordable Care Act is reducing health care costs for early retirees. As of December 31, 2010, more than 5,000 employers had been accepted into ERRP, more than $535 million in health benefit costs have been reimbursed through the program, and those payments have helped benefit more than 4.5 million Americans." [, 3/2/11]

Expanding Preventive Care To Seniors

Medicare Recipients And Seniors With Private Health Insurance Are Eligible For Free Preventive Care Services. The Affordable Care Act automatically extends free preventive care for those enrolled in Medicare. Additionally, CBS News reports that the law "[r]equires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles." By 2018, this requirement applies to all private health insurance plans. [CBS News, 3/21/10]

The Affordable Care Act Provides Disease Prevention And Screening For:

  • Cancer: Breast, Cervical and Colorectal Cancer
  • Diet: Cholesterol, Obesity and Blood Pressure
  • Bones & General Wellness: Osteoporosis and aortic aneurysm

[U.S. Preventive Services Task Force, August 2010]

Medicare Recipients Are Eligible For Free Annual Wellness Visit. According to AARP: Seniors "will no longer have to pay for Medicare-approved preventive care services. ... The new preventive benefits start in 2011 and include ... [a] free annual wellness visit." [, November 2010]

More Than 150,000 Medicare Beneficiaries Have Received A Free Annual Wellness Visit So Far In 2011. From a March 16, 2011, Health and Human Services news release: "Today, the Department of Health and Human Services (HHS) released a new report showing that 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 health care professional, thanks to the Affordable Care Act, along with many other recommended preventive services. ... Many more people with Medicare are expected to receive annual wellness visits and other recommended preventive services thanks to the Affordable Care Act." [, 3/16/11]

Protecting Seniors From Insurance Company Tricks That Can Deny Or Rescind Coverage

The Affordable Care Act Prohibits Insurance Companies From Dropping Coverage For 'Unintentional Mistakes' On Applications. From "Right now, insurance companies are able to retroactively cancel your policy when you become sick, if you or your employer made an unintentional mistake on your paperwork...Under the regulations, insurers and plans will be prohibited from rescinding coverage - for individuals or groups of people - except in cases involving fraud or an intentional misrepresentation of material facts. Insurers and plans seeking to rescind coverage must provide at least 30 days advance notice to give people time to appeal. There are no exceptions to this policy." [, 7/1/10]

  • Over 10,000 People Each Year Have Their Coverage Dropped "Because They Get Sick And Made An Unintentional Mistake On Their Application." From "Approximately 10,700 people whose coverage is dropped each year because they get sick and made an unintentional mistake on their application will not have their coverage rescinded." [, 12/9/10]

The Affordable Care Act Eliminates Lifetime Price Caps On Insurance Coverage. According to AARP: "Currently, more than 100 million Americans have insurance that stops when medical claims exceed their policy's lifetime limit. ... The law phases out these annual limits over a period of three years: in the first year, insurers must cover medical expenses up to at least $750,000. That coverage rises to $1.45 million after Sept. 23, 2011 and increases to $2 million after Sept. 23, 2012. Limits will be completely banned starting Jan. 1, 2014." [, 8/23/10]

The Affordable Care Act Helps To Deliver A More Efficient Health Care System

The Affordable Care Act Cracks Down On Waste, Fraud, And Abuse. From The Hill: "Healthcare providers would be subject to new screening measures based on their level of risk to federal health programs, under new proposed regulations released by the Centers for Medicare and Medicaid Services. The fraud, waste and abuse prevention measures were called for in the new healthcare reform law. [...] Improper payments cost federal health programs about $55 billion a year." [The Hill, 9/20/10]

The Affordable Care Act Provides Tools To Crack Down On Health Care Fraud. From the Seattle Times: "Investigators have new tools this year to help crack down on health care fraud, with the Justice Department and the Health and Human Services Department working cooperatively to police companies. The newly enacted Affordable Care Act is designed to lengthen prison sentences in criminal cases and the new law provides an additional $300 million over the next 10 years for stronger enforcement. It also gives the government new authority to step up oversight of companies participating in Medicare and Medicaid." [Seattle Times, 5/13/10]

The Health Care Law Combats Fraud From Several Angles. According to the U.S. Department of Health and Human Services:

Specifically, the proposed rule will:

  • Establish the requirements for suspending payments to providers and suppliers based on credible allegations of fraud in Medicare and Medicaid;
  • Establish the authority for imposing a temporary moratorium on Medicare, Medicaid, and CHIP enrollment on providers and suppliers when necessary to help prevent or fight fraud, waste, and abuse without impeding beneficiaries' access to care.
  • Strengthen and build on current provider enrollment and screening procedures to more accurately assure that fraudulent providers are not gaming the system and that only qualified health care providers and suppliers are allowed to enroll in and bill Medicare, Medicaid and CHIP;
  • Outline requirements for states to terminate providers from Medicaid and CHIP when they have been terminated by Medicare or by another state Medicaid program or CHIP;
  • Solicit input on how to best structure and develop provider compliance programs, now required under the Affordable Care Act, that will ensure providers are aware of and comply with CMS program requirements.

[U.S. Department of Health and Human Services, 9/20/10]

The Affordable Care Act Improves The Quality Of Long-Term Care

The Affordable Care Act Provides Expanded Medicaid Services And Options That Can Help Seniors With Home Care. According to the Kaiser Family Foundation, the Affordable Care Act "provide[s] states with new options for offering home and community-based services through a Medicaid state plan." It also "establish[es] the Community First Choice Option in Medicaid to provide community-based attendant supports and services to individuals with disabilities who require an institutional level of care" and "provide[s] states with an enhanced federal matching rate" to help with the costs of the program. [Kaiser Family Foundation, Summary of the Health Reform Law]

The Affordable Care Act Helps Eliminate Abuse At Long-Term Care Facilities. According to Families USA: "Through the Elder Justice Act provisions of the Affordable Care Act, for the first time, there will now be a dedicated source of federal funding for Adult Protective Services offices - state agencies that provide services to abused, neglected, or exploited seniors and people with disabilities." In addition, the law expands a program that checks applicants who would work directly with those in long-term care against abuse and neglect registries. According to Families USA, "the pilot program prevented more than 9,500 people with histories of abuse or violent criminal records from ever working with seniors or people with disabilities. This successful program will now be conducted in every state, ensuring that people with a history of neglect or violence are not put in a position to take advantage of, or harm, our seniors and people with disabilities." [Families USA, October 2010]

The Affordable Care Act Improves Government Services And Quality Of Care For The Elderly. According to Health and Human Services, the Affordable Care Act makes grants available to Aging and Disability Resource Centers (ADRCs). Per a description from the Centers for Medicare and Medicaid Services, "ARDCs play a critical role in supporting health and long-term care reform by improving the ability of State and local governments to effectively manage the system, monitor program quality, and measure the responsiveness of State and local systems of care." [U.S. Department of Health and Human Services, 9/27/10; Centers for Medicare and Medicaid Services, 5/20/10]

The Affordable Care Act Connects Seniors With Community Services To Prevent Unnecessary Hospital Readmission. According to "The Community Care Transitions Program will help high risk Medicare beneficiaries who are hospitalized avoid unnecessary readmissions to the hospital by coordinating care and connecting patients to services in their communities." [, accessed 1/27/11]

  • ACA Provides $500 Million For Partnerships Between Hospitals And Community-Based Organizations. According to "TheCommunity-Based Care Transitions Program,a provision of the newly enacted Patient Protection and Affordable Care Act ... provides $500 million to collaborative partnerships between hospitals and community-based organizations designed to meet the goal of implementing evidence-based care transitions services for Medicare beneficiaries at high risk for hospital readmission." [, 4/29/10]