Seniors and the Affordable Care Act

As Californians gear up for the final phase of health-care reform in January, seniors around the state are still wondering what to expect.

At a recent Senior Awareness Day event in Modesto, several people wandered between booths in the basement of the city library, gathering information about fitness programs, hospice care and legal advocacy. Many had questions about Medicare, the national health insurance program for some young people with disabilities and people over 65.

Frank Dotson, 83, was one of the volunteers fielding questions. Dotson is a counselor for the Health Insurance Counseling and Advocacy Program (HICAP), a state program that helps Medicare beneficiaries learn more about their available coverage options.

The new health-care reform law started affecting Californians on Medicare after it passed in 2010. However, there’s still a general lack of knowledge about the benefits, said Maria Profeta, 42, the HICAP program manager for Stanislaus county.

“Seniors hear about the Affordable Care Act, and how it’s going to help young people,” Profeta said. She and the rest of the HICAP team often have the task of explaining how the new law will affect Medicare coverage.

One way is by reducing and eventually closing the prescription drug “doughnut hole.” Before the new law, people who were on Medicare were forced to pay expensive, full-cost prices for their medications after they passed a deductible limit, and before they reached another, higher price cap.

But the new health care law reduces the amount that patients have to pay out of pocket and gradually phases out this gap in coverage, so seniors won’t have to shell out full price for their medications anymore. Seniors on Medicare currently receive a fifty percent discount on several brand name drugs, and, by 2020, this coverage gap should disappear.

There are other features of the new law that have gone into effect. Among these are free yearly wellness visits and preventative screenings for diabetes and cancer. “The biggest change so far is that it is providing a lot more preventative services,” Dotson said.

This could have far-ranging effects on the health of a substantial number of seniors. According to the California HealthCare Foundation, California has the largest number of Medicare enrollees of any state at 4.5 million.

Health-care reform will help younger seniors (ages 50-64) as well, said Christina Clem of AARP California.

One change that will affect younger seniors is that health insurance companies can no longer deny someone coverage based on preexisting conditions. Insurance companies will also be prohibited from kicking a patient off of an existing plan if after they become ill, Clem said.

Insurers will also be prohibited from charging older people more than five times more than younger people pay for the same coverage. Currently older people can pay five times more or more.

The new insurance exchanges like Covered California also make direct comparison across programs a simpler process, she added. Additionally, all health plans have to cover ten “essential benefits” which include less frequently covered services like mental health treatment and rehabilitation.

By expanding health coverage for the 50-64 population, the hope is that people’s overall health will be better by the time they move into the Medicare age range.

“We’re hoping that the cost expended for coverage for that population will eventually decrease at some point, because people are going to come into the program with hopefully fewer chronic conditions, or chronic conditions that are managed,” Clem said.

Expectations about the health-care reform roll out are varied.

Monica Norstrom, a paralegal with the Senior Law Project in Modesto, said that in the past eight months the center had seen an increase in clients who were concerned about not being able to afford their health insurance premiums, and anticipated more questions come January.

“Nothing has really changed,” said Jill Erickson, Manager of Aging and Veteran Services for Stanislaus County. The only differences she has noticed have been expanded preventative services. “Everything’s been positive as far as the consumer is concerned,” Erickson said, adding that she thought it was too early to be able to give people much information about the future changes in January.

Two elderly women leaving the Senior Awareness event at the library said they were not concerned about how the new health-care reform law would affect them.

In the meantime, organizations are planning different approaches for educating the general public. AARP California is planning to post more information on their state blog and host informative events, as well as contacting members by phone before open enrollment for the new health insurance exchanges begins in October.

Maria Profeta, the Stanislaus HICAP program manager, said that they had been ramping up their local counseling and informational sessions. In early June, HICAP will be offering a class in health insurance counseling for people who are interested in becoming volunteer counselors for other seniors, who might have questions about how Medicare works. They are especially looking for bilingual volunteers, including people fluent in Farsi and Portuguese.

Everyone is anticipating many more questions as health-care reform rolls out.

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