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What Kinds of Changes Can Older Americans Expect Under Health Reform?

September 26, 2013 at 12:00 AM EDT
How does the Affordable Care Act alter Medicare or other insurance coverage for older Americans? Mary Agnes Carey of Kaiser Health News joins Ray Suarez to answer some of your most frequently asked questions.
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JUDY WOODRUFF: Now another in our ongoing look at where we try to answer questions about the Affordable Care Act.

Ray Suarez is in charge.

RAY SUAREZ: Tonight, a look at Medicare and what private sector retirees might face under the new law.

For that, we welcome back Mary Agnes Carey of Kaiser Health News. Kaiser Health News is an editorially independent news service focusing on health policy.

And a lot of people still have very basic questions as to what the Affordable Care Act is going to mean to them. How is it going to change the way they acquire health care? I headed out into the streets of Washington, found people from all over the country still had questions, like this woman from California.

WOMAN: My name is Janet Nielsen. I am from California, live outside of San Francisco.

As a senior citizen, I’m concerned how the Medicare rates are going to be affected. Right now, I have Medicare with Kaiser as a supplement, and I have been very satisfied. But I’m concerned both as to Medicare and my insurance company how rates will be affected and how our care will be affected as well.

RAY SUAREZ: And let me add again that her insurer, Kaiser Permanente, is not related to Kaiser Health News, your organization.

There must be a lot of people in this boat who are Medicare recipients and also acquire some private insurance.

MARY AGNES CAREY, Kaiser Health News: They do.

And first I want to add to her concern about benefits. There will be no benefit cuts in the Affordable Care Act for Medicare beneficiaries. There are actually additional benefits, more screenings without co-pays or deductibles, additional help for your Medicare prescription drug costs.

But I think what she’s talking about is some concern about payment reductions to Medicare providers. The law does cut payments to hospitals and home health agencies and some other providers over the next decade. But the thought is that those sectors can sustain the payments and stay in the Medicare program.

But there’s some concern that, if the Medicare cuts are too deep, over time, would these providers decide to leave the program? There’s no evidence of that yet, but that had been some concern.

RAY SUAREZ: And will her Medigap costs go up because it’s private insurance, like that that so many other people buy?

MARY AGNES CAREY: Well, there’s no changes to Medigap as part of the Affordable Care Act. That’s a separate pricing system. Those are private insurers, as you note. So it’s hard to know that, what would happen to Medigap.

RAY SUAREZ: We have questions that have been coming in over the Internet and via e-mail.

One, “Will there be age limits on services to patients under the Affordable Care Act? I have heard that for people over 65, they won’t be able to get a hip replacement or cancer treatment. Is this true?”

MARY AGNES CAREY: No, it’s not true.

There’s absolutely no age restrictions on anyone to get a medical service. Perhaps this person is a little concerned about a new advisory board that’s created as part of the health law that, if Medicare spending went beyond a certain level, this board would provide recommendations to Congress on how to control spending.

If Congress didn’t adopt those recommendations, they would have to come up with recommendations of their own. But it’s important to know several things here. No one has been nominated to this panel. They face Senate confirmation, which will be pretty difficult in this partisan environment. And Medicare isn’t even expected to hit these targets until 2022 or beyond. So it’s not really even a factor yet in any part of the Medicare discussion.

RAY SUAREZ: But are there problems for people who are making the transition from the health care they have had for a long time into Medicare? Is there — or do the two mesh up easily when you move from one to the other, maybe at the end of a working career?

MARY AGNES CAREY: Well, many people for now in their working lives are part of managed care. They’re already receiving — perhaps they have a health maintenance organization or a preferred provider organization. They may be comfortable going into Medicare Advantage, which are the private plans in Medicare that provide care to beneficiaries, or they may choose to be in Medicare’s traditional fee-for-service program.

RAY SUAREZ: Let’s go to another question.

Our next person writes: “I will be 65 in January and know I will have to go onto Medicare and a Medigap plan. My husband is on my employer’s family policy and will not be eligible for Medicare until June. Should I be looking to another insurance via Obamacare for him for the next several months? And how do we go about getting a Medigap plan via Obamacare?”

MARY AGNES CAREY: I have a few recommendations here.

One thought is, could her husband stay on her health insurance plan through a program called COBRA? It’s fairly expensive. Instead of paying a part of the premium, you pay the full freight and administrative fee. That’s one option.

They might also be able to get coverage for her husband on the health insurance exchanges, these online marketplaces created in the health law. And they might actually qualify for a subsidy based on their income. So they should look into the exchanges for coverage for him.

RAY SUAREZ: Another person writes: “My husband and I will be negotiating the exchanges due to an unexpected condition. I am an IBM retiree and now going to lose IBM coverage for both me and my spouse, along with about 110,000 others.”

MARY AGNES CAREY: Well, this is a really interesting question that’s caused a lot of confusion.

What’s happening for the IBM retirees is the Medicare-eligible retirees are being placed in a private exchange. This has nothing to do with the exchanges created in the health law. IBM and other employers have decided to give their retirees a set amount of money, let them go into an exchange that sometimes offers more coverage choices for their retirees and let them pick that.

But, again, I want to stress it has nothing to do with the exchanges in the health care law.

RAY SUAREZ: So, in effect, they haven’t been thrown into the marketplace that the state of New York will be putting into place?

MARY AGNES CAREY: No, they have not been. These are separate exchanges for this particular Medicare eligibility — Medicare-eligible, rather, population.

RAY SUAREZ: COBRA, is anything going to change about COBRA now that the Affordable Care Act is coming fully into force?

MARY AGNES CAREY: Well, you may have few people sign up — fewer people, rather, sign up for it because it is so expensive for the beneficiary, and they might get a better deal on the health insurance exchange.

RAY SUAREZ: Mary Agnes Carey of Kaiser Health News, thanks for joining us.

MARY AGNES CAREY: Sure. Thanks for having me.