Health Care Reform Act

Affect on Medicare and Medicaid

What is the impact of the 2010 Health Care Reform Act on the Medicare and Medicaid federal long term health care programs?

Any Benefits Reduced?
The traditional Medicare program benefits are not going to be reduced. The only Medicare spending cuts are to Medicare Advantage which uses private insurance to administer benefits. The government currently pays the private plans an average of 14 percent more than traditional Medicare.

Many of the Advantage providers have additional coverage which could be discontinued as the Medicare Advantage subsidies are adjusted to be comparable to traditional Medicare benefits. The plan is for Medicare Advantage rates to remain the same in 2011 and reduced gradually to allow time for adjustment.

Medicare Benefit Changes
The biggest changes approved by the health care reform act to the Medicare national health care insurance is for annual wellness checkups and increased payments to primary care providers. Medicare currently only covers the cost of the initial checkup when first covered by the Medicare federal long term health care.

Prescription Drug Changes
The Obama health care plan improves Medicare prescription coverage. Presently the current Medicare national health care insurance has a big gap in coverage – often referred to as a “donut hole”. This gap starts when $2,700 is spent on prescriptions and resumes at $6,154 – a gap of over $3,000 in coverage.

Beginning in 2010, insured who fall into this gap receive a $250 rebate. Starting in 2011 Medicare participants receive a 50 percent discount on brand name prescriptions. By 2020, the gap in coverage will be closed with 75 percent of prescription cost coverage.

Medicare Payroll Tax
While most employed will not see an increase in the payroll tax as a result of the health care reform act, those making over $200,000 a year for individuals and $250,000 for couples will see an increase. The current 1.45 percent rises to 2.35 percent for those exceeding these income levels. The health care bill also applies the tax to certain investment income for these higher income Americans.

Changes to Medicaid
Medicaid is the national health care insurance for lower income adults and their children. The health care reform act impact to the Medicaid federal long term health care program is fairly significant. Primary care physicians receive an increase in payments to make them comparable to Medicare rates.

Medicare rates are about 20 percent higher than Medicaid. The reasoning is to increase the number of doctors who will accept Medicaid patients as it’s anticipated several million more Americans will be eligible for coverage under the health care bill. However the higher payments only apply to primary care physicians – not for specialists.

Beginning in 2014, those with incomes below 133 of the poverty level will be eligible for Medicaid coverage. States cannot cut people from Medicaid until the health care exchanges established by the health care reform bill are available in 2014 – 2019 for children.

Medicare Savings
The 2010 health care bill includes provisions to save Medicare money. Medicare will try payment systems in an attempt to promote coordination of benefits and more efficient care.

The intent is to avoid duplication and better coordination in care for those with chronic conditions. A quality verses quantity approach.

Other initiatives of the health care reform act are the creation of an advisory board to recommend money saving ideas and additional funding to fight fraud and abuse.

Find more information here on the Health Care Reform Bill impact on medical billing.

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