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The Affordable Care Act: Top 5 Things Caregivers Need to Know

The Affordable Care Act: Top 5 Things Caregivers Need to Know

The Affordable Care Act (ACA — also known as Obamacare) is continuing to roll out, and it’s still in flux. The best way for caregivers to prepare for future changes is to arm themselves with knowledge and watch out for changes as they happen. We’ll explore ways you can help your senior now while you prepare for the future.

1. New Medicare Benefits for Seniors

Kaiser Health News reports that Medicare beneficiaries will receive new benefits as a result of the Affordable Care Act. New preventive care services include a yearly “wellness” visit (annual physical), colorectal screening, and mammograms. These services are free under the ACA and not subject to co-pays, according to US News.

2. Part D Doughnut Hole Is Closing

Medicare.gov says the Affordable Care Act is gradually removing the coverage gap (doughnut hole) in Medicare prescription drug coverage. This can save seniors on multiple expensive medications a significant amount of money. Some seniors “extend” their medication, taking less of it, due to the financial burden of the doughnut hole. Familiarize yourself with the new provisions and make sure your senior understands the new benefits.

3. Medicare Advantage Plan Benefits

Some Medicare Advantage Plans, private insurance policies that replace standard Medicare, often remove the need for “Medigap” insurance and sometimes include prescription benefits. They may have changed. Since most policies change annually, compare several plans each year before renewing. You can find and compare plans interactively at Medicare.gov.

4. Doctors, Hospitals and Prescription Drug Benefits

It’s important to find out if your loved one’s doctors and hospitals are still in your network and/or are accepting Medicare/Medicare Advantage patients. Verify that in-network doctors will remain in network even if the policy names them. Make a note of any hospital changes in case a hospital visit becomes necessary, and make sure your loved one’s doctors have privileges at in-network hospitals. If your senior has to change doctors, make an appointment with each new doctor for a date immediately after the policy goes into effect to “reserve your spot”—or while your senior is still on the old policy if the doctor is in network on that policy. A 2013 survey conducted by Merritt Hawkins, an executive health care search firm, revealed the average wait time for new patients across 15 cities and five specialties is 18.5 days, but if you make the first appointment in advance, your senior may not have to wait.

If your senior takes a lot of medication, try to find the policy with a formulary that includes the most expensive drugs. This, too, can change from year to year.

5. Stay Abreast of Changes to the Affordable Care Act

If you don’t have time to watch or listen to the news to keep up with changes, check in regularly with Medicare.gov to see what, if any, changes have been announced. That way, you’ll be able to plan for them, or at the very least, you won’t be surprised when they come.

There have always been many variables to consider when finding the best medical care for seniors. Now that the Affordable Care Act is rolling out, caregivers need to keep a sharp eye out for even more changes. This is an instance of an ounce of investigation and planning on the caregiver’s part being worth a pound of cure for the senior.

Check the Philips Lifeline blog regularly for news affecting caregivers and tips for maintaining a healthy work-life balance.

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