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Health Reform Benefits and Resources for Seniors

on Fri, 01/04/2013 - 4:44pm

There are provisions in the Affordable Care Act specifically tailored to meet the needs of America's senior citizens.


  • One of the most important aspects of the Affordable Care Act is the development of a new, competitive private health insurance market available to residents of each state. If you're under 65 and don't have Medicare or Medicaid coverage, you can find coverage and pricing options with your state’s health insurance marketplace. Health Insurance Marketplaces are designed to keep prices low and to enhance quality. Enrollment begins on October 1, 2013 with coverage beginning as early as January 1, 2014.
  • Depending on your income and household size, you may qualify for savings on your monthly premiums or lower out-of-pocket costs for private insurance. Other provisions that may save you money include efforts to reduce waste, fraud, and abuse, increased care coordination, external review of large premium increases, and incentivization of innovation.
  • Those seeking individual or private plans have numerous new protections within their plans, including:
    • The removal of annual and lifetime dollar amounts on benefits
    • The removal of pre-existing condition exclusions
    • Access to certain preventive care services such as screenings and annual checkups with no cost-sharing obligations under a health plan
    • Protection from having the insurance company drop coverage from honest mistakes within the insurance application
    • No more coverage denials without the right to appeal
  • Improved quality of care due to the fact that 80 percent of enrollee premiums collected by insurance companies must be spent on patient care and quality improvements, as well as new incentives to promote adoption of electronic health records


  • To help patients fully understand their health coverage, all health plans must present the “summary of benefits” in a consistent, easy-to-understand and standard format, allowing the consumer to easily compare coverage options during the application process and at renewal.  In addition, each plan must showcase the costs associated with two coverage examples, allowing better understanding of the potential out-of-pocket expenses related to care.
  • For those older adults not yet eligible for Medicare, starting January 1, 2014, an insurer cannot charge an older person more than three times the rate of a younger person’s premiums, reducing high pricing based simply on age


For those seniors that are enrolled in Medicare or Medicare-eligible:

  • Medicare coverage is protected: Under the health care law, your existing Medicare-covered benefits cannot be reduced or taken away.   If you are already covered by Medicare, you do not have to do anything!
  • The Affordable Care Act works to close the Medicare Part D "donut hole" resulting in savings in prescription costs. In 2011, Medicare Part D patients started receiving a 50 percent discount on brand name drugs while in the "donut hole".   The law completely closes the "donut hole" for all prescription drugs in 2020.
  • Seniors enrolled in Medicare will not have to pay for specific services identified in the list of preventive care, like mammograms or colonoscopies, without charging within the Part B coinsurance or deductible.   These preventive services will be covered at no cost, including a free annual wellness check.  
  • The health care law helps stop fraud with tougher scrutiny and licensing procedures for providers and suppliers, stronger penalties, and new technology.
  • Improving Care Coordination and Quality: Through the newly established Center for Medicare and Medicaid Innovation, this Administration is testing and supporting innovative new health care models that can reduce costs and strengthen the quality of health care.  

Additional Resources

The Medicare website - Specifically tailored to the new Medicare patient and offers a variety of resources to better explain their plan options. Patients can learn about preventive services, personal health records and the basics of all Medicare plans. Patients can compare the different health plans, find a doctor, compare hospitals and find suppliers of medical equipment. Patients can also register for, a free service which allows patients to create a personalized account and access their Medicare information online.

A Clear View to Medicare – Making the Most of Your Benefits – Patient Advocate Foundation’s publication helping those newly eligible for Medicare understand the process and components for successful enrollment.  

Information for those that are both eligible for Medicare and Medicaid - Medicaid is a program funded both by federal and state governments to provide health coverage to patients whose incomes make them eligible. It can sometimes be confusing for patients to determine whether or not they qualify for Medicaid, as there are different categories of care. Pregnant women, seniors over 65, children up to age 19 and blind and disabled individuals can qualify if you meet all of the other eligibility requirements.