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Life Health > Health Insurance

Preventive Care for Retirees Gets Huge Boost Under Obamacare

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Medical technology is advancing at an incredible rate, and patients young and old are recovering from diseases that were death sentences just a few decades ago. Even so, prevention is still far better than cure. People are living longer, but not necessarily healthier, and it’s critical that current and soon-to-be retirees preserve their well-being by proactively managing risk factors.

Fortunately, the Affordable Care Act has provided for several preventive health measures for Medicare recipients. The ACA reduces or eliminates out-of-pocket costs for a variety of life-saving screenings, and patients now enjoy increased access to their doctors before they get sick.

Whereas patients used to receive only a one-time “Welcome to Medicare” visit during their first year of coverage, they now receive an annual wellness visit with a primary care provider at no out-of-pocket cost. While not a full physical, each of these visits involves a comprehensive health risk assessment. Physicians question patients on their recent injuries and urgent needs, but they also discuss risk factors that could contribute to chronic diseases. These risk factors are compiled into patient records along with family and medical histories, which doctors then use to create screening schedules for their patients.

In most cases, Medicare also covers those subsequent screenings. “The great thing for Medicare recipients is that they’re going to provide all preventive screenings at no out-of-pocket cost,” said Shelley Alexander, osteopathic doctor and owner of New You Health Studio in Leawood, Kansas. While Medicare beneficiaries once had to pay 20% for most preventive services, the program now covers screenings for cancer, depression, obesity, diabetes and a host of other chronic illnesses.

In addition to these screenings, Medicare also now covers counseling, cessation and coaching programs for patients who need to alter their lifestyles. These programs include tobacco cessation, alcohol counseling and even nutritional consultations for people with diabetes and other special dietary needs.

For cases where preventive screenings and lifestyle changes aren’t enough, the ACA also mandates greater prescription drug coverage. Before the law went into effect in 2011, Medicare Part D recipients were responsible for 100% of their drug costs once they exceeded their yearly coverage limits until they hit the yearly out-of-pocket spending limit. From 2011 to 2020, this “doughnut hole” will gradually be closed through manufacturer discounts and increased government contributions. As of 2013, consumers must pay 47.5% for brand-name drugs and 79% for generic drugs during the yearly gap. By 2020, both of these figures will be reduced to just 25%.

Because of the ACA’s incentives for employer-provided health care, hopeful retirees can start to save — and improve their health — even before they go on Medicare. Most companies are now offering participatory health programs such as gym memberships, health seminars and rewards for employees who complete screenings. These programs are outcome-independent, and employers are required to provide them equally, regardless of participants’ current health.

The ACA also provides coverage for “health-contingent” programs, which require participants to achieve specific outcomes outlined by their physicians. These outcomes may include a certain BMI, blood pressure or cholesterol level, or they may involve demonstrable reductions in tobacco use, drinking or other habits. Most coaching and counseling services are covered at 30%, though employers will typically provide half the costs for tobacco cessation programs.

Old age doesn’t have to bring poor health or high medical costs. “Old age in and of itself does not cause disease,” said Alexander. “A disease process has to be in place.” Whether they seek the screenings and consultations now available through Medicare or opt for out-of-pocket anti-aging services, retirees need to take preventive measures to preserve their health and savings. Spending small amounts of time and money up front will ultimately prevent major setbacks later in life.


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