Good and bad to be found in Affordable Care Act, but bottom line for Medicare recipients is no exchange
A sizable crowd gathered Tuesday at Pinckneyville Community Hospital to learn how the Affordable Care Act or "Obamacare" will affect Medicare and Medicaid recipients. James E. Schuh of the Illinois Department of Aging's Senior Health Insurance Program cautioned Medicare recipients not to share their information with telemarketers trying to get them to buy insurance through the exchange set to go online Oct. 1.
"Just tell them you're not interested and hang up," Schuh said. "It is illegal to sell Medicare insurance through the exchange."
Open enrollment for Medicare begins Oct. 7. Call the Department of Aging at (217)524-3263 for help with enrollment or choosing a Medicare supplement insurance program.
While the Affordable Care Act does bring some changes to Medicare, it does not determine the premiums. There was a formula created in 1997 as part of the Balanced Budget Act that determines Medicare Part B premiums.
Changes ACA will make to Medicare include a list of about 20 preventative procedures which are now free of charge and closing the Medicare Prescription Drug 'donut hole' which requires some recipients to pay all or a larger percentage of drug costs up to a certain amount.
The greatest goal of the ACA is to end Medicare Advantage Plan overpayments and weed out Medicare fraud. Schuh said that Central Management Services (CMS) has a panel of doctors that review Medicare records to determine if testing is necessary and will benefit the patient.
"Regular insurance companies have been doing this for years," Schuh said. One difference is that the review will take place on the back end. Medicare recipients will still get the tests and treatments ordered by their doctors. They do not have to justify procedures first and will not be billed for any procedures deemed unnecessary by the panel. The provider will simply not be reimbursed.
The ACA will have a greater impact on Medicaid recipients. Illinois is one of the states that has chosen to expand their Medicaid programs. Beginning in January 2014, single adults who made less than 133 percent of the federal poverty limit and who are under 65 years of age will be eligible for Medicaid.
Schuh said that the expansion is expected to bring $4.6 billion in federal funding in Illinois.
Some Medicare recipients will also be eligible for Medicaid in addition to Medicare. The 'dual eligibles' have three savings programs to choose from. There are asset limits on each. Homes, one automobile and a burial plan of up to $1,500 are not assessed as assets. Also, there is no estate recovery action in any of the three programs.
Schuh said he was neither for nor against the ACA, but was enthusiastic about the accountability the ACA will bring to the Medicare system.
Of the approximately 320 million U.S. residents, some 256 million already have insurance coverage and will not be affected by the ACA.
One group that may not benefit from ACA is those who have been part of Illinois' high-risk insurance pool. That program is ending and former pool members will have to choose a plan through the exchange.
The ACA does not allow insurers to deny coverage to anyone. However, it does not set limits on premiums.
"You'll have to go to the exchange and shop," Schuh said. He said the coverage might cost more than the high-risk pool and it might cost less. He does not know.
Illinois does not have its own exchange. Illinois residents will be shopping on the federal exchange. The government should begin publicizing the web address and telephone numbers of the exchange soon. Enrollment is set to begin Oct. 1.