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There are many benefits of the Affordable Care Act (ACA), from increases access to quality health care, to making it more affordable to get comprehensive health insurance and strengthening primary care to prevent the most common chronic illnesses. But some of the biggest benefits of the ACA are specifically for seniors. And you can feel the difference in your pocket.

Closing the prescription drug “donut hole”

The ACA makes Medicare prescription drug coverage more affordable by gradually closing the coverage gap known as the “donut hole.” This is the gap in coverage between where beneficiaries had to pay the full cost of their prescriptions out of pocket before catastrophic coverage took effect.

Since the ACA health care law’s enactment in 2010, anyone with a Medicare Part D prescription drug plan who reached the prescription drug donut hole got a $250 rebate. Since the law’s enactment, across the country, 7.9 million seniors and people with disabilities saved an average of $1,265 on prescription drugs. Federal Centers for Medicare & Medicaid Services (CMS) data shows that in 2013 alone, over 4.3 million Medicare beneficiaries received an automatic discount on their prescription drugs after reaching the drug coverage gap. These discounts for seniors and people with disabilities will continue to grow over time until the “donut hole” is fully closed in 2020.

Providing Free Preventative Services

The Affordable Care Act also contains critical provisions covering preventative health services at no cost to the consumer. For seniors on Medicare, there are even more provisions for other preventive services without cost sharing, eliminate coinsurance, and remove the Part B deductible for preventive care services. In fact, according to new data released by CMS, more than 25.4 million people covered by Original Medicare received at least one preventive service at no cost to them during the first eleven months of 2013.

“Thanks to the Affordable Care Act, millions of seniors have been able to receive important preventive services and screenings such as an annual wellness visit, screening mammograms and colonoscopies, and smoking cessation at no cost to them,” said CMS Administrator Marilyn Tavenner. “Prevention and early detection are so vital to ensure that Americans are healthy and Medicare is healthy. The Affordable Care Act makes Medicare stronger and improves the well-being of millions of beneficiaries who have taken advantage of preventive services and wellness visits.”

Savings are big in Massachusetts

Seniors in the Commonwealth are feeling the effects of the new health care law. In 2012,  nearly  60,000 Massachusetts seniors saved an average of $667 each on drugs including a 7% discount on covered generic medications for people who hit the donut hole. This grew even more last year, when more than 67,000 individuals received an average discount of $823 each including a 14% discount on generics and a 50% discount on brand name prescription drugs. These benefits from ACA amounted to $9.6 million in savings across the Commonwealth. In addition, at least 878,048 Massachusettsians received at least one free preventive service in 2013 .

Because of the ACA prescription and preventative medicine reforms, seniors stay healthy and health care providers are better able prevent, identify and treat problems earlier.

Are you a Massachusetts resident or caregiver with questions about Medicare coverage? The SHINE program is here to help. Click here for more information.

To read the full CMS report, click here.

For more information on the donut hole coverage, visit: http://www.medicare.gov/pubs/pdf/11493.pdf

For more information on the free preventive services, visit: http://www.hhs.gov/healthcare/prevention/seniors/medicare-preventive-services.html

Written By:


Communications Fellow

Deputy Communications Director, Office of Health and Human Services

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