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The Affordable Care Act (ACA) has introduced new measures to further fortify the Medicare health care plan for senior citizens.  The revised Medicare health plan provides preventive medical care benefits, offers discounts on prescribed drugs, and improves the controversial ‘Donut-hole’ coverage gap.

How the new plan benefits you?

Since January 1, 2011, Medicare has seen the introduction of many preventive care policies and benefits that include yearly wellness visit, counseling sessions for tobacco discontinuation and various free medical screenings.

For new entrants to the Medicare plan, there will be no charges levied for the annual “Welcome to Medicare” physical exam. The free of cost services will also include counseling sessions and other preventive health care and services.

Medicare now considers tobacco use cessation counseling as a preventive health measure, irrespective of whether or not you have been diagnosed with an illness related to tobacco usage. The counseling is a covered feature, but co-insurance and other deductibles charges will be applicable, if the patron has been diagnosed with a tobacco related ailment prior to insurance.

For many related medical screening services, including diabetes, cancer and various chronic disorders, no co-payment or deductibles will be charged, provided several Medicare coverage criteria have been met.

Drug Discounts and $250 Donut hole reimbursement

The new Affordable Care Act has amended the unfavorable coverage gap in the Medicare Part D drug prescription plan.

What is the Donut Hole?

Under the original Medicare plan, a beneficiary may be liable to pay the initial $ 310 of his or her drug costs, known as the ‘deductible’ amount. During the initial coverage phase of the Part D plan, the beneficiary has to pay the co-insurance, until the total expenditure on drugs reaches a limit of $2,840. Once this coverage limit is crossed, the controversial ‘donut hole’ gap in coverage begins. Once in the donut hole gap, the patron has to bear 100% costs for all prescribed drugs until the drug expenditure rises to $4,550. It is important to note, that this amount excludes the premium insurance payments.

How the new plan benefits you?

For beneficiaries enrolled in the Medicare Prescription drug plan or Medicare Advantage plan with prescription drugs coverage, the new act offers relief during the dreaded donut-hole phase.

Since January 1, 2011, all patrons who have crossed their initial coverage phase and are presently in the coverage gap, a 50% discount on all covered brand-name drugs has become effective. The discount is provided automatically, whenever a consumer buys over the counter drugs or orders drugs through mail, until the net prescription amount reaches $4,550 known as the catastrophic limit.  From this amount onwards the co-payment coverage option resumes under the catastrophic phase.  This measure will bring down the out-of-the-pocket costs every year until complete coverage of the donut hole becomes effective in 2020.

While in the Donut phase, the beneficiaries can also avail a 7% discount on the generic drugs.

The earlier tax free one time rebate of $250 that was paid during the donut phase has been discontinued under the new act.

Further strengthening of the Medicare plan

The new reforms in Medicare will now address factors such as fraud, excessive waste of resources and slow cost growth, to ensure better premiums and cost savings in the future.

– Measures have been put in place to check fraudulent activities, abuse and payment errors.
– To prevent stressful re-admission to hospitals for recurring conditions, the revised Medicare aims to provide better quality of health care and improved coordination between doctors.

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