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How does the Affordable Care Act Affect Seniors?

Original Publication: San Antonio Express News, March 26, 2010

As you know from all the media coverage, health care reform has worked its way through the politics of Washington. The whole concept of changing the system generated great controversy and passion, both for and against. Suspicion can now be examined against the actual words making up the Patient Protection and Affordable Care Act, contained in HR 3590. Several adjustments were made to the Act in HR 4872, which was passed last week as well.

This column will focus on several provisions which have impact on the Senior community.

1. The new law phases-out Medicare Part D’s “donut hole” coverage gap on prescription medications for Seniors. In 2010, there will be a $250 rebate to certain Medicare beneficiaries, and by 2020 the hole should be closed altogether. The new law also seems to give the Secretary of Health & Human Services (HHS) authority to negotiate drug prices with manufacturers, which could save taxpayers and consumers billions of dollars.

2. Medicare Part C, which provides for “Medicare Advantage” options, will face a funding equalization with Medicare Parts A & B. Today, someone who enrolls in a Part C plan costs Medicare on average $135 per month more than it costs to provide care to someone enrolled under Parts A & B.

The companies that provide the Part C plans will be paid the same amount per enrollee that they would be paid if the enrollee remained under Parts A & B. Despite the cut, Part C plans are forbidden from trimming medical care except for items that were already optional, like health club memberships and vision or dental care. Also, financial rewards are established as incentives to maintain the quality of care under Part C plans.

3. For the first time, Seniors will be allowed an annual wellness visit – a free annual checkup. There will be no co-pay or deductible for the check up, and the service will include creation of a personalized prevention assessment and plan. Routine care with the goal of preventing serious illness can improve quality of life and reduce program costs.

4. A new voluntary insurance program to cover at-home care for the aged and disabled has been authorized. It is called the “CLASS Act”, the acronym for “Community Living Assistance Services and Supports”. The goal is to allow persons with functional deficits (the inability to perform various activities of daily living) to receive care in their homes instead of forcing them into institutional care.

The CLASS program will start slowly. Employers may arrange to enroll employees in the same manner that employees enroll in a 401k plan (though employees can decline to participate if they so choose). The self-employed and others outside the Employer enrollment system will be given their own chance to opt-in. A premium will be paid by the enrollee, and benefits will become vested after a person has been enrolled for 60 months, which is similar to Social Security’s requirement that you pay into the system for 40 quarters before benefits vest.

When a vested enrollee is determined to need and to qualify for assistance, benefits will include funds to pay for at-home care giving, home modifications, assistive devices, accessible transportation, homemaker services, respite care for family, and personal assistance and nursing support. The details will be worked out in Regulations to be issued by the Secretary of HHS in October 2012.

5. The much discussed “death panels” did not become law, and were not really death panels anyway. The proposal to pay doctors to discuss end-of-life issues with patients was withdrawn. End-of-life issues are still a stark reality, however, and each of us should ponder our own wishes and sign proper legal documents that enforce our instructions. You can work with your lawyer on those issues, and can check our Virtual Law Office at for more discussion and online documents.

6. The new law includes provisions to discourage elder abuse, neglect and exploitation, called the Elder Justice Act. It will coordinate the efforts of federal, state and local agencies that protect the elderly. It will provide grants to support local Adult Protective Service agencies and to shore up local Long-Term Care Ombudsman programs.


Paul Premack is a Certified Elder Law Attorney and a Five Star Wealth Manager (Texas Monthly Magazine 2009-2013) practicing estate planning and probate law in San Antonio.


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