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Medicare and Obamacare

By Peter Lipton, MD

Medicare, the government program that guarantees access to health insurance for Americans 65 or older, has been around for 48 years. Despite nearly a half century of existence, and tremendous popularity, Medicare decisions can be a bit perplexing when you confront them for the first time. The implementation of the Affordable Care Act, known informally as Obamacare, is adding to the confusion. I’m a doctor, not an insurance expert, but one of my specialties is gerontology so I have considerable experience with Medicare patients. Will Obamacare affect Medicare? Yes. It already has. But before I try to sort out the realities and myths for you, let’s talk about Medicare, in general, first.

Dr. Peter Lipton of Palm Desert

Dr. Peter Lipton of Palm Desert

If you are 65 or are about to be, you are probably aware that Medicare is broken up into an alphabet soup; Parts A, B, C, and D. There are supplemental plans you can add which can substantially lower your out-of-pocket costs. You might want to cover long-term care, dental, hearing and vision. Meanwhile, Medicare Open Enrollment is going on right now. This is the relatively short window when current Medicare recipients can make changes to their coverage, changes that take effect in the new year. The medical group I belong to, Empire Physicians holds free, informative Medicare seminars during this time. Many groups do this and if I could, I’d write you a prescription to attend one! They really help clarify the choices you have and help you make the best decisions.

Now let’s separate fact from fiction, reality from rumor, regarding Medicare and Obamacare.

I’m not sure how this got started but Medicare is not ending. Most experts believe Medicare will become stronger once the Affordable Care Act is fully in effect.

The rumor that seniors receiving Medicare will have to buy more insurance to comply with the new law is not true. One of the controversial, key provisions of the ACA is the individual mandate. It requires people who are uninsured to purchase coverage or pay a penalty. If you have even the most basic Medicare, you have coverage. You don’t need to buy anything more.

Have you heard that Medicare patients will pay more for meds under Obamacare? Well, this is true, but not for everyone. Seniors who earn more than $85,000 per person or $170,000 per couple will pay slightly more for prescription drug coverage (that’s Part D of Medicare). This will affect about 5% of Medicare beneficiaries. The other 95% should see drug costs go down. You’ve probably heard of the “donut hole.” It’s basically a coverage gap which the ACA is expected to fully close by 2020. In the meantime, if you fall into the gap, there are discounts you can take advantage of. There’s a 47.5% discount on brand name drugs and a 21% discount on generics. The discount is applied right at the pharmacy — you don’t have to do anything to get it.

Speak with your doctor about their Affordable Care Act choices

Speak with your doctor about their Affordable Care Act choices

Medicare premiums are going up! Yes, that’s true, but they always have. As costs go up, premiums follow and that has been the case long before the ACA was implemented. Here again, individuals earning more than $85,000 and couples earning more than $170,000 pay more for Medicare Part-B coverage. They’ve been paying more since 2007 before the ACA.

Rumor has it that Obamacare will prevent Medicare patients from seeing their current physicians. Nothing in the Affordable Care Act changes which doctors Medicare patients can see, but hospitals, physicians, pharmacies and other providers can withdraw from Medicare.

So, if your doctor continues to accept Medicare patients, you can continue to see your doctor.

One of the best ways the ACA has affected Medicare is in preventative services. Medicare now covers many without charge, including mammograms, colonoscopies, colorectal cancer screening, and vaccinations. Simply put, these can save your life. Obamacare is now part of the mix. It has already had an effect on Medicare with more to come. No one can be 100% certain where Medicare is headed because no one knows where medical discovery will lead us. We have to keep in mind that it’s only been 85 years since penicillin was discovered. It’s only been 61 years since Jonas Salk and the polio vaccine. It’s only been 46 years since the first heart transplant. One hundred years ago, the average lifespan for a man was 50 and for a woman, 55. Modern medicine is changing both the quantity and quality of life.

Dr. Peter Lipton is Board Certified in Internal and Geriatric Medicine and located in Palm Desert. Dr. Lipton is with Empire Physicians Medical Group and has been serving the Coachella Valley for more than 15-years. For more information about Empire Medicare Seminars, call (760) 699.6390.

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