For Seniors

Health reform will bring a number of improvements and additional benefits for consumers – but at a cost. These changes looks different for every consumer. Rates will be higher, but some customers will pay less than they do now. Some will pay more. Find out more about health care reform and how you can get the most benefit from the law.

What does health care reform mean for seniors?

Part D

Medicare Part D (the part of Medicare that covers prescription drugs) has famously had a coverage gap, or “doughnut hole,”” since it was established in 2003. The coverage gap was when a beneficiary reached $2,830 in drug expenses and persists until $4,550, leaving many exposed to the high costs of needed medicine.

The Affordable Care Act took steps to close this gap by:

  • Issuing $250 rebate checks in 2010.
  • Planning for gradually reducing the coverage gap through discounts.
  • Creating a new, quicker process to make beneficiaries eligible for catastrophic coverage.

In the spotlight: Health Care Reform and Medicare Part D

Medicare Advantage

Medicare Advantage (or Part C) coverage is a way of providing Medicare through a private insurer, usually covering more services than traditional Medicare Parts A and B. The Affordable Care Act makes sweeping changes to reimbursement to Medicare Advantage plans, lowering reimbursement overall but providing bonuses for reaching certain quality ratings. The health care reform law requires some preventive services, including an annual wellness exam, to be covered at no cost to the Medicare Advantage enrollee. BCBSNC provided no-cost wellness exams before the law was in effect.

In the spotlight: Health Care Reform and Medicare Advantage

Prevention

The Affordable Care Act does a lot to boost access to preventive services and encourage consumers to use them. Health care reform also requires that many preventive services be provided at no cost to the consumer, such as colonoscopies and contraceptive services.

In the spotlight: Health Care Reform and Prevention

Pharmaceuticals

Pharmaceutical companies account for a growing portion of health care spending. Like all health sectors, the pharmaceutical industry is impacted by the Affordable Care Act. Beginning in 2011, pharmaceutical companies that make brand name drugs will pay an annual assessment to help fund a portion of the health law (in 2012 and 2013 the aggregate fee was $2.8 billion).

In the spotlight: The Pharmaceutical Industry

Medigap

Medigap coverage offers Medicare beneficiaries protection from the high out-of-pocket cost-sharing responsibilities for enrollees of Medicare Part A (hospital insurance) and Part B (medical insurance). These plans typically cover people in rural areas without access to Medicare Advantage plans, no access to employer-sponsored retirement plans, and incomes too high for Medicaid to supplement Medicare. About 19% of North Carolina residents have this supplemental coverage. The Affordable Care Act requires the National Association of Insurance Commissioners (NAIC) to review the two Medigap policies with first-dollar coverage for potential revision to include “nominal cost-sharing to encourage the use of appropriate physician services under (Medicare) Part B.” The new benefit standards are to be made available beginning January 1, 2015.

In the spotlight: Medicare Supplement

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For Individuals

Health care reform means more benefits and improvements, but at a cost.
Learn More

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For Seniors

Some consumers will pay less than they do now for health insurance. Some will pay more. Learn More

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For Employers

Tax credits and more health insurance purchasing options for businesses in NC. Learn More

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ACA Timeline

The impact of health care reform changes looks different for every consumer. Learn More