The Affordable Care Act (ACA) of 2010 (also referred to as health care reform) included a number of provisions that affect people with Medicare, as well as those aging into Medicare.
Enhanced preventive benefits for people with Medicare
Under health care reform, people with Medicare now have little to no costs for many preventive services. Some of these services include:
- An Annual Wellness Visit
- Cancer screening tests such as mammograms and colonoscopies
- A Welcome to Medicare physical
A full list of covered preventive services offered to people with Medicare is available in the Resource Library.
Cost savings in the Part D prescription drug coverage gap
The Medicare Part D coverage gap, sometimes called the donut hole, occurs when seniors exceed a certain amount on their prescription drug costs during the year. Previously, seniors who reached the donut hole would be responsible for paying the costs of their prescriptions in this gap. The Affordable Care Act is helping to close the coverage gap. Currently, if someone reaches the donut hole they receive discounts on their drug costs. By 2020, the coverage gap will be entirely gone.
Medicare and the Marketplace
In addition, ACA expanded health coverage to all Americans through the creation of federal and state Marketplaces where individuals and small business can purchase insurance. These Marketplaces are designed for individuals who do not have Medicare, yet many people may have questions about how they work for older adults, and how those enrolled in Marketplace plans can effectively transition to Medicare when they first become eligible. Get information on this in our two fact sheets:
- Transitioning to Medicare from Expansion Medicaid FAQ
- What People with Medicare Need to Know about the Marketplaces FAQ
It is important to note that no Medicare products are sold in the Marketplace. Seniors who wish to buy Medicare Advantage, Part D prescription drug, and Medigap (supplemental) plans should continue to do so through Medicare.gov, Medicare plan brokers, or the plans themselves. Older adults can also get assistance in finding coverage that suits their situation through NCOA’s My Medicare Matters.
Contact your state Marketplace
You can get in touch with your state’s Marketplace in two ways:
- Visit Healthcare.gov (the official Marketplace website) and select your state from the menu, or
- Contact the Marketplace call center, available 24/7, directly at 1-800-318-2596.