1. Straight Talk for Seniors: How Will Health Care Reform Change Your Health Care?
June 2013

2. National Council on Aging (NCOA)
Improving the lives of older Americans since 1950
Enhancing Economic Security
Improving
Health
Strengthening Community Organizations

3. Just the Facts About….
The A-B-C-D’s of Medicare
Health Reform Changes to Medicare Finances
How Health Reform Changes Affect YOU

4. 1
Section 1 - How Medicare’s 4 sections are financed
The ABCD’s of Medicare

5. The A-B-C-D’s of Medicare
Part A –
Hospital Insurance
Inpatient care, including skilled nursing
Paid for by payroll taxes
Concerns about future solvency

6. The A-B-C-D’s of Medicare
Part B - Outpatient Health Insurance
Pays for additional medical services (like doctors visits, diagnostic tests, and outpatient care)
Financed 75% by general revenues, 25% by monthly premiums ($ in 2013)

7. The A-B-C-D’s of Medicare
Part C - Medicare Advantage (MA)
Private health plans (e.g. HMOs and PPOs) that deliver Medicare services
24% of Medicare recipients are in MA C

8. The A-B-C-D’s of Medicare
Part D - Prescription Drug Coverage
You choose your plan
Includes a coverage gap for “donut hole”
Paid for by general revenues

9. The A-B-C-D’s of Medicare
Many believe that rate of spending on Medicare cannot be sustained
The number of people with Medicare will grow rapidly as Boomers age.
Medicare spending is increasing faster than the rest of the economy.

10. Health Reform Changes to Medicare Finances2
Health Reform Changes to Medicare Finances

11. Financial Changes to Medicare
Increased Revenues
Higher payroll taxes for wealthy workers ($200/$250,000)
Higher Part D premiums for 5% of higher-income Medicare beneficiaries ($85/$170,000)
Reduced Spending
Slower growth in payments to providers (not doctors)
Reduction in over-payments to Medicare Advantage plans
Average yearly Medicare spending increases down overall and down per person

12. Health Reform Financial Changes to Medicare
Medicare solvency extended for 12 more years
Increased funding to improve some Medicare benefits

13. What About the Federal Budget Deficit?
Congressional Budget Offices estimates health reform will save $124 billion over 10 years. !

14. How Health Reform Changes Affect You3
How Health Reform Changes Affect You

15. How These Changes Affect YOU
Changes in Doctor Payments
The law provides a 10% bonus for primary care doctors
The law did not address the long-standing problem of future cuts in doctor fees, which has been a problem for more than 10 years, but that Congress consistently delays in separate bills.

16. How These Changes Affect YOU
Improvements in Medicare Prescription Drug Coverage
2010: $250 Rebate check for those who hit donut hole
2013 & 2014: 52.5% discount on brand name Rx
2020: Coverage gap completely closed

17. How These Changes Affect YOU
Better Preventive Care
Free annual wellness visit and prevention plan
No more cost sharing – most preventive benefits free
More funding for prevention services

18. How These Changes Affect YOU
Better Chronic Care
New quality improvements
Pilot projects and demonstrations to test better coordination among doctors, specialists, other providers
Incentives to reduce hospital readmissions
Help so you can manage your own care

19. How These Changes Affect YOU
Other Improvements
Incentive to companies to help keep premiums down for early retirees
New protections against elder abuse, neglect, financial exploitation
Better training for workers caring for seniors
Nursing home quality improvements +

20. How These Changes Affect YOU
Greater Access to Medicaid Home and Community Long-Term Care Services
Help to stay at home – if your state adopts these important options
Financial protections for spouses
Program to leave nursing homes
Voluntary public long-term care insurance program for full and part-time workers (CLASS)

21. How These Changes Affect YOU
What about Medicare Advantage Plans?

22. Reduced Payments to Medicare Advantage Plans
MA plans are paid about $1,100 more per person than people in original Medicare (13% higher)
Payments frozen in 2011
These overpayments are being gradually reduced

23. How These Changes Affect YOU
Changes in Medicare Advantage (MA) Plans?
Some plans may eventually reduce extra benefits, increase premiums or even leave the program
New bonuses to reward high quality care
New consumer protections to limit out-of-pocket costs

24. If you have a Medicare Advantage plan
Don’t panic, but get informed.
Shop around – research your options at
Learn if you are eligible for Medicare Savings Programs, Extra Help for Prescription Drugs and/or other benefits (go to
You can always return to Original Medicare.

25. What’s New with Medicare in 2013:
Free preventive services to improve health and well-being
Easier-to-read summary of benefits
Save more when you reach the prescription drug coverage gap
Pay less for outpatient mental health treatment
Pay slightly higher premiums for Medicare

26. How Health Reform Affects Your Children and Grandchildren
Insurance Protections
Children up to age 26 will be covered under their parent’s policies (2010)
No one will be denied coverage because of pre-existing conditions or dropped because they get sick (2011)

27. How Health Reform Affects Your Children and Grandchildren
CBO estimates that 32 million currently uninsured Americans will have health insurance.
New tax credits and tools will help contain costs and improve quality – so we all get better VALUE.

28. Five Facts – The New Law Will:
Not cut basic Medicare benefits — and it will make some benefits better.
Reduce Medicare spending and the federal deficit, and extend Medicare’s solvency by twelve years.
Help people find and pay for long-term care at home.
Improve health care for seniors in other ways.
Improve coverage and protections for younger Americans with and without health insurance.

29. Straight Talk for Seniors: Will Health Care Reform Change Your Health Care?
For more information:
North Central Texas Area Agency on Aging
Mary Jane Douglas and Melinda Gardner
Provide your local SHIP counselor information.

30. Straight Talk for Seniors: Will Health Care Reform Change Your Health Care?
For more information:
1-800-MEDICARE