Caring for Crohn’s Affordable Care Act Primer Part 3:

January 12, 2013 at 3:31 pm Leave a comment

In the third installment of the Caring for Crohn’s Affordable Care Act Primer, I explore the aspects of the law that affect those 65 and older.

The Affordable Care Act is designed to strengthen Medicare, make preventive services affordable, and close the “donut hole” (discounts on medications that fall in the coverage gap.

  • Medicare Preventive Services: Under the ACA, if you have the original Medicare, you may qualify for a range of preventive services for free, including a yearly wellness physical, tobacco use cessation counseling, and screenings for cancer, diabetes, and other chronic diseases. Effective: January 1, 2011
  • Medicare Drug Discounts: If you reach the coverage gap in Medicare Part D coverage, because of the ACA, you will automatically get a 50 percent discount on covered brand-name drugs. You will receive the discount when you purchase the medications at a pharmacy or by mail until you reach the catastrophic coverage phase. Additionally, you will also get a seven percent discount on generic drugs while in the “Donut Hole.” Effective: January 1, 2011
    • Here is the schedule of what you’ll pay for medications until the “Donut Hole” is closed in 2020:
      • 2012: you’ll pay 50% for brand-name drugs and 86% for generic drugs
      • 2013: 47.5% for brand-names and 79% for generics
      • 2014: 47.5% for brand-names and 72% for generics
      • 2015: 45% for brand-names and 65% for generics
      • 2016: 45% for brand-names and 58% for generics
      • 2017: 40% for brand-names and 51% for generics
      • 2018: 35% for brand-names and 44% for generics
      • 2019: 30% for brand-names and 37% for generics
      • 2020: 25% for brand-names and 25% for generics
  • $250 Donut Hole Rebate:  In 2010, if you had Medicare prescription drug coverage and paid for your drugs in the “donut hole” coverage gap, you received a one-time tax-free $250 rebate from Medicare to help pay for  prescriptions.
  • Strengthening Medicare: The ACA extends the life of the Medicare Trust Fund until at least 2024. This will provide you with future cost savings on premiums and co-insurance.



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