ACA / Obama Care Changes to Medicare

Health care costs continue to rise and as we age we need to use more health care

Medicare is a government insurance program that functions within a large private medical practice.  In other words what makes Medicare attractive is low cost out of pocket premiums paid to the government which in turn pays the bill of privately run facilities and staff.  Many fear this attractiveness is going to change as the government becomes more deeply involved in the private medical market.

The changes currently put into practice: 

  • Require pharmaceutical companies to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage cap; begin phasing-in federal subsidies for generic subscriptions filled in the Medicare Part D coverage gap.
  •  Improve coverage provided for certain preventive services.
  •  Provide Medicare beneficiaries with access to a comprehensive health risk assessment and creation of a personalized prevention plan, including incentives to complete behavior modification programs.
  • Freeze 2011 Medicare Advantage payments at 2010 levels to begin transition to reformed subsidy payments to Medicare Advantage plans.
  • Prohibit   Medicare Advantage plans from requiring higher cost-sharing arrangements for some Medicare covered benefits than is required under Traditional Medicare.
  • Freeze the income threshold for income-related Medicare Part B premiums for 2011 through 2019 at 2010 levels.
  • Reduce the Medicare Part D premium subsidy for those with incomes above $85,000 individual/$170,000 couple.

ACA, Obama Care Medicare Changes Starting in:


  • Provide bonus payment to high-quality Medicare Advantage plans.
  • Reduce rebates for Medicare Advantage plans.


  • Begin phasing in federal subsidies for brand-name prescriptions filled in the Medicare Part D coverage gap.


  • Reduce the out-of-pocket amount that qualifies an enrollee for catastrophic coverage in Medicare Part D.
  • Require Medicare Advantage plans to spend at least 85% of premium dollars on medical services.

At first it looks like ACA is improving care and the cost of drugs for seniors.  For basic routine health care this is certainly true. However, in order to save future health care dollars drug therapies plan to be used in place of high cost surgeries. In any given case this may or may not be desirable but most would agree this decision should be left to the doctor and their patient. There are hundreds of pages in the ACA which direct government health boards to approve or deny certain high dollar procedures mostly based on age and productiveness of the patient.

You may ask questions in the comments or contact me privately Tim Barton, ChFC

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