Tracking changes in health insurance can be a frustrating task, but this year, many seniors may find that the changes are encouraging — and cost-saving. With the implementation of the Affordable Care Act and related changes to Medicare, seniors should have more coverage, and more benefits, than before.
The new law protects Medicare benefits and expands coverage to include more preventative care, such as a yearly wellness visit, screenings for diabetes and certain cancers, diet counseling and immunizations, according to AARP, which offers tip sheets, live webinars on the topic and a “Health Law Answers” tool at AARP.org.
The law also provides more prescription drug coverage for seniors who fall under the Medicare Part D coverage gap, sometimes called the “doughnut hole.” Percentage discounts for out-of-pocket drug costs are set to decrease each year until 2020, when the gap should be eliminated, according to the association.
Accountable Care Organizations and more coordinated care
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One of the more significant changes is the creation of Accountable Care Organizations — a network of doctors and hospitals, based around a patient’s primary care physician, that shares responsibility for providing coordinated care — said Larry Clark, senior vice president and chief public policy officer with LeadingAge PA. The association, in Mechanicsburg, represents nearly 400 not-for-profit organizations that provide health care, housing and community services to the elderly.
Seniors whose primary care physician is part of an Accountable Care Organization should be receiving notices about Medicare Accountable Care Organizations and the sharing of their medical information among health care providers through electronic health records, Clark said.
“The exchange of information electronically through an electronic health record gives the physician and the long-term care provider the ability to share medical records and other relevant information in almost ‘real time’ and improves the quality of care,” he said.
“An electronic health record is a natural fit within an Accountable Care Organization, because the aim of the ACO is the coordination of care among various health care providers.”
He offers an example: LeadingAge PA staff are working on statewide guidelines and best practices that direct-care workers can use to identify the changing psychological/social needs of seniors with Alzheimer’s disease or dementia. Those changes in care can be recorded in the electronic health record and shared immediately among a physician, a care manager and direct-care workers.
“This increases the effectiveness and quality of the care because the right care can be provided at the right time,” Clark said.
Seniors can opt out of the electronic information exchange, he added, by contacting their providers.
“A Medicare Accountable Care Organization is extremely beneficial in that it offers seniors preventive care and chronic disease management at a time when it is probably most needed in their life,” he said. “And this care has the best outcomes when there is coordination and communication among all the health care providers from the physician to the direct care worker in the long-term care setting.”
For additional information, seniors can visit CMS.gov and choose “Medicare” at the top left of the navigation bar, then the “Accountable Care Organizations” link under “Medicare Fee-For-Service Payment.”
The state’s Department of Aging offers the Apprise program, a free counseling service for older adults to help them understand Medicare. The program also trains volunteer counselors to offer objective information to older Pennsylvanians shopping for health care coverage.
Those who are younger than 65 and not covered by Medicare or Medicaid now can purchase plans through pahealthoptions.com.
“Counselors are kept up to date and trained to know about plans in various areas so they can give them an objective overview or help evaluate plans,” said Christina Reese, department press secretary.
The toll-free Apprise helpline is 800-783-7067, and all services are free and confidential.
Medicare.gov offers a search bar into which seniors can type in a test, health item or service to see whether it’s covered by Medicare. They can also find tools to compare physicians and other health care professionals.
For those who are younger than 65 and don’t have Medicare or Medicaid, coverage and pricing options also are available at HealthCare.gov in the Health Insurance Marketplace. Applicants may qualify for savings on monthly premiums or lower out-of-pocket costs for private insurance.
An increased focus on primary care
Because the new law and Gov. Tom Corbett’s proposed HealthyPA Initiative push health care providers to focus on primary care — and better quality care (bonus payments are to given to providers who treat people with Medicare and provide quality care, as rated by patients) — many hospital administrators are working to update and expand access to primary care, or the point at which patients first encounter health care to treat a new problem.
At Mount Nittany Health, options for older patients are increasing, spokeswoman Nichole Monica said in a statement:
“According to legislation in the Affordable Care Act, those with Medicare are offered new benefits and protection, especially as it relates to the accessibility of quality, affordable health care. The health care law covers preventive care for our aging population, including a yearly wellness visit, mammograms, colonoscopies, diabetes screenings, immunizations and more. Because of these expanded benefits, many area health care providers — such as Mount Nittany Health — are increasing the breadth and depth of primary care services. In the past year, Mount Nittany Health has recruited more than 20 new providers to Mount Nittany Physician Group, including the opening and expansion of a family medicine practice in Mifflin County.
“Now, Mount Nittany Physician Group offers 15 convenient locations across the region, and is one of the largest networks in the area with more than 100 providers,” Monica said.