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Seniors and Obamacare (the Affordable Care Act)

Original Publication: San Antonio Express News, September 30, 2013

Dear Mr. Premack: We are hearing everywhere that October 1 is when Obamacare starts. I hear and see lots of news and ads criticizing Obamacare and don’t want to have to pay extra taxes or change my doctor because of this law. As a Senior, I feel that Washington should keep its nose out of my personal health care and leave my health issues between me and my doctor. Since Congress can’t seem to kill this law, what actions do I have to take now as a Senior to comply with the law? – N.S.

As a Senior (who I’ll assume is 65 or older) it is ironic that you want Washington to keep its nose out of your health care. You must realize that being covered by Medicare means you are part of the largest national health care program run by the government. Washington is already deeply involved in health care for Seniors. Despite the news and ads, Obamacare (legally called the Affordable Care Act or ACA) has improved coverage under Medicare and, despite reports to the contrary, does not require Seniors to pay extra taxes or change their doctor.

According to the Center for Medicare and Medicaid Services (CMS, the federal bureaucracy that manages Medicare) if you are covered by Medicare or Medicaid, or are retired under the Federal Employee Health Benefits plan, then you do not need to be concerned about the Health Insurance Marketplace established by the ACA. Whether you are enrolled in Original Medicare or a Medicare Advantage Plan, you can stay with your current plan under the ACA. You do not need to buy private health insurance and this October 1 launch of the Health Insurance Marketplace has no effect on you.

The ACA further provides Medicare beneficiaries, who are Seniors like you, with more preventive services and eliminates some out-of-pocket costs. For example, under the ACA:

  1. New Medicare enrollees get a no-cost “Welcome to Medicare” wellness visit with their doctor. It is not a complete physical, but rather a conversation about your medical history and about steps which can be taken to maintain your health.

  2. Certain preventive services, like mammograms or colonoscopies, will be covered and you won’t have to pay any coinsurance or deductible under Medicare.

  3. Your prescription drug coverage may become less costly. If you spend enough on prescriptions to reach the donut hole (where you begin to pay out-of-pocket under the rules established under President Bush) you will begin to receive 50% discount on brand-name prescription drugs. CMS says that the discount will be applied automatically at your pharmacy without action on your part. Additionally, the ACA will eliminate the donut hole by year 2020.

  4. You will receive a no-cost annual wellness visit with your doctor. As part of the annual wellness visit, the doctor is supposed to offer to discuss your legal advance directives.

Discussing advance directives with your doctor must be approached correctly. You should use the discussion to understand what effects advance directives may have on your health care and to better understand how the doctor will react to your directives. You should use the discussion to provide your doctor with copies of your already signed advance directives. But you must avoid allowing your doctor to supply forms for those directives (and please, don’t get them on the internet either). Why?

Every time I’ve see forms provided by doctors or via the internet, the forms have been faulty and of questionable legal validity. The doctor or doctor’s staff cannot legally assist you to prepare advance directives because doing so would be unauthorized practice of law. Advance directives can only legally be prepared by 1) yourself for yourself, 2) a specially certified benefits counselor at an Area Agency on Aging, or 3) your licensed attorney. Your doctor is not a lawyer, and does not keep up with the federal or state laws related to advance directives. Your elder law attorney does stay up-to-date with those laws, and should be your source for proper and legal advance directives.


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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