Medicare does not pay for long term care expenses

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

9 Responses

  1. EFH

    Thank you for writing this article. I feel a great deal of denying surgeries are already taking place where I live. My husband had PAD and has already been told that he will never be a candidate of surgeries. If anything happens he is to come to the ER and they will adjust or add to the already 9 drugs he is taking now. In light of the reality, he will most likely choose not to go in, since he realizes they won’t be doing anything for him. He is over 69 and was told this info. 2 years ago. Our quality of care is changing for our seniors. I am very concerned
    how these changes will impact our faith in the medical profession and whether people may choose to forfeit care.

  2. Oh yes, the devil is in the details. Don’t know how anybody can say that they like it, when so much is still unknown … inspite of some two thousand plus pages. Really scary ………

  3. Sharon

    I drew the same conclusion from that last sentence: 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. That does sound like Palin’s “death panels.”

    There is a meme going around Facebook which suggests that hip replacement is not covered under ACA. Is it covered?

    1. There is a lot speculation about what is covered and what is not covered. This is because the ACA bill does not spell it out, rather it referrs to “what the secretary shall decide” or some other appointed board like IPAB. The various boards have either not been setup or have not taken any specific action yet. So at this time I do not think anyone, at this point knows about any specific condition’s coverage.
      Thanks for your comment Sharon.

  4. TK

    If your line of thought was aimed at hip replacement and the like, you should have specified. When I read you interpretation as the gov’t replacing high-cost surgeries with drug therapies I thought of heart disease and other life-threatening ailments. You could easily remedy that still by adding a few words to what you wrote.

    And c’mon, you really don’t see the connection to “death panels”?
    Sarah Palin said that the, “unproductive members of society could face the prospect of government bureaucrats determining whether they deserve health care.”
    Sounds pretty close to your words.

    I’m just glad that we agree that the gov’t should NOT be involved in making medical decisions for its citizens. The specific decisions should be between a patient, a doctor, and that’s it.

    1. I see no connections with what I wrote to death panels. As I read ACA, so far, I have seen no reference to death panels.
      However, there are references to productive and unproductive some references to the medical procedures and others to patient’s life quality. ACA law specifically states IPAB cannot refuse a patient lifesaving care.
      All of my business peers advised me against writing about this topic because it was too politically charged. I am involved in retirement planning and this law contains some massive changes. It is my belief clients deserve an advisor who understands all things affecting their retirement planning. There is more to people’s lives than dollars and cents.
      Thanks again for your comment.

  5. TK

    You provide facts and then you end with a paragraph invoking Sarah Palin’s death panels. Leave the hyperbole out and stick to the facts.

    1. Thank you for your comment. Forgive me as I fail to see any connection with my post. What “death panels” are you talking about?
      In the last paragraph my thought was on something like a hip replacement verses managing it via drug therapy. This is a quality of life situation not life or death.
      Currently I am studying how the Independent Payment Advisory Board (IPAB) will operate and will be posting my interpretation soon. According to ACA the IPAB will be empowered to make Medicare cost-cutting recommendations. If you have or know of some interpretations of how this will work please feel free to provide that information.

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