How Did the Supreme Court Decision Affect Retirees?

Those of us that are in the middle of, or are approaching that age that categorizes us as “senior”, can look to some positive impacts from the Supreme Court ruling on the PPACA legislation.

If you’re over age 65 and on Medicare, the Affordable Care Act (ACA) improves your benefits. If you’re over 50 and don’t have insurance through an employer, the “exchanges” should improve your options for health coverage by 2014. In fact, there are approximately 9 million seniors between the ages of 50 to 64 that have lost coverage and are uninsured, that should have more options available through the “exchanges” in their State residency.

Let’s look at how PPACA enhances health benefits for seniors between the ages of 50 – 64. First, the application process for a policy will be based on your income:

  • Middle income seniors and/or their families (less than $92,000 annually for family of four) are eligible for a federal subsidy of between 2% to 9.5%.
  • Lower income seniors and their families (less than $30,000 annually for a family of four) will be included in the “new” Medicaid expansion program within PPACA.

On the bright side, the application process has eliminated the worry of denial based on pre-existing conditions, and the higher premiums typically associated with health and age risk factors.  However, what has not yet been put-in-place is the implementation process of securing coverage through the State Exchanges.  States have been afforded “choice” of whether to open an exchange or not.  This will prove to be a stumbling block to the “access” for seniors in the States that choose not to “play-ball”.

For those seniors over the age of 65 and already on Medicare, there are some immediate benefits already being realized that are slated to continue:

  • PPACA has expanded preventive services for all seniors with no out-of-pocket costs.  This is a great benefit for all in the long-term promotion of our health and lifestyle, and keeping healthcare costs in-check in the prevention of disease and acute health conditions.
  • Prescriptions for seniors within the Medicare Part D program continues to improve with the gradual “shrinking” of the gap coverage through raising of the spending threshold limits for seniors (in 2012 that gap coverage is $2930 to $4700).  By 2020 the gap coverage will be eliminated.
  • Seniors are realizing a 50% Manufacturers’ discount on Brand Name drugs (and 14% on Generics) in the gap coverage being funded by the Pharmaceutical companies.  This has been a life-saver for many seniors that could not afford these prescriptions without this assistance. [The Dept of Health and Human Services calculates that in 2011, over 3.5 million seniors saved over $2 billion; and in first 4 months of 2012 nearly a half million seniors have saved an average of $724 on prescriptions.]

Whether we are in favor or not of PPACA, there are positive benefits for seniors in PPACA.  Let’s figure-out how to fund these benefits in a way that will be responsible and afford seniors the opportunity to have access to health care.  This may prove to be a “tall-order” given the current political climate facing us in the November election. Let’s hope seniors are not sacrificed!

About Vince C

Vincent Cerilli has been directly involved with the healthcare industry for over 25 years. For the past 10 years he has focused on the senior market in an advisory and consulting role to employers and seniors regarding their Medicare coverage and supporting healthcare plan needs.
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