Exemptions to the Individual Mandate
There are some cases where there is no penalty to not having coverage.
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.
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.
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 www.kdads.ks.gov/commissions/commission-on-aging/medicare-programs/shick should be able to give consumers more information about how their existing coverage works with Medicare.
The new federal law doesn’t change those benefits.
You should contact your employer’s human resources department for help.
If you need more information about how Medicare and retiree benefits work together, you can contact the Senior Health Insurance Counseling For Kansas (SHICK) at www.kdads.ks.gov/commissions/commission-on-aging/medicare-programs/shick or call 800-860-5260.
This article is published on KansasMoney.gov. Find more information by contacting these state agencies: