Parts of Medicare Affected by the Affordable Care Act

Last updated: March 30, 2016

Medicare Supplemental Insurance Is Unaffected by the ACA

The Medicare Prescription Drug “Donut Hole” Is Closing

The ACA began closing the “donut hole” in 2011. It’s expected that the “donut hole” will be closed by 2020.

  • This affects Medicare beneficiaries whose prescription drug costs are greater than the Part D deductible.

    • They will need to pay only a 25% coinsurance rate until their expenditures reach the catastrophic level.

  • The “donut hole” is being closed by:

    • 1. Combining a 50% discount on the cost of brand-name drugs

    • 2. With a gradual increase in the share of prescription drug costs (for both generics and brand-name drugs that Medicare pays)

  • It will be officially closed when a beneficiary only owes 25% of the total cost.

Medicare Advantage Plans Are Affected by the ACA

1.The ACA implemented quality incentives for Medicare Advantage plans.

  • These give advantages to doctors and physicians who accept Medicare.

2. It limited plans’ ability to require cost-sharing on certain high-cost services.

  • This means some Medicare Advantage plans may cover more costs.

3. The ACA reduced the federal payments to the Medicare Advantage program. They did this to line up payments for Medicare Advantage plans more closely with the traditional Medicare program.

  • This may mean higher premiums or reduced coverage under some Medicare Advantage plans.

Is There Anything That I and My Dependents Who Are Already on Medicare and Employer-Based Coverage Need To Do Because of ACA?

Generally, No

There’s typically nothing you need to do if you’re already on Medicare and have employer-based coverage.

  • If you have coverage through an employer, and that employer’s current benefits pay first and Medicare pays second, the ACA doesn’t change that.

If the employer changes the benefits that cover you or your dependents, then they will send you a notice about those changes.

  • You can ask their employer’s human resources department how those changes work with Medicare.

The Senior Health Insurance Counseling For Kansas (SHICK), 800-860-5260 or at should be able to give consumers more information about how their existing coverage works with Medicare.

Is There Anything That I and My Dependents Who Are Already on Medicare and Have Retiree Coverage From an Employer Need To Do Because of the ACA?


The new federal law doesn’t change those benefits.

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